腹腔镜胃切除术治疗老年胃癌患者的短期及长期结局

Short and long-term outcomes of laparoscopic gastrectomy for elderly patients with gastric cancer

目的比较行腹腔镜胃切除术的老年患者与中年患者的短期及长期结局。方法 2010年1月-2016年12月,共有58例年龄大于或等于70岁的胃癌患者(老年组)行腹腔镜胃切除术,这58例患者与同期因胃癌行腹腔镜胃切除术的159例中年患者(年龄60~69岁,中年组)进行短期与长期结局的比较。结果术前一般资料比较方面,老年组的年龄、Charlson合并症指数、既往腹部手术史及美国麻醉医师协会(ASA)分级高于中年组,其余的术前一般资料比较差异无统计学意义。老年组与中年组在手术时间、术中失血量、术后30 d并发症发生率及严重程度和病理结果等一般资料比较差异无统计学意义。长期随访结果表明,两组患者的肿瘤复发率类似。两组患者的总体生存率及无瘤生存率均类似。结论腹腔镜胃切除术用于老年胃癌患者可取得与中年患者类似的短期及长期结局,年龄不是行腹腔镜胃切除术的禁忌证。

Obejective To compare the short and long-term outcomes of elderly and middle-aged patients with gastric cancer who underwent laparoscopic gastrectomy.Methods From January 2010 to December 2012,58 patients with gastric cancer aged≥70 years(elderly group)underwent laparoscopic gastrectomy,and their short and long-term outcomes were compared with those of 159 patients with gastric cancer aged 60~69 years(middleaged group)who underwent laparoscopic gastrectomy during the same period.Results With respect to the patients’preoperative baseline characteristics,the elderly group had a higher age,a higher Charlson comorbidity index score,rate of previous abdominal surgeries,and American Society of Anesthesiologists(ASA)classification score compared to those for patients in the middle-aged group.There were no significant differences in the other baseline characteristics.There were no significant between-groups differences in the duration of surgery,intraoperative blood loss,incidence and severity of 30-day postoperative complications,and pathological results.Long-term follow-up results showed that the tumor recurrence rates were similar between the two groups,as were the overall and diseasefree survival rates.A multivariate analysis showed that age was not an independent predictor of overall and diseasefree survival.Conclusion In summary,laparoscopic gastrectomy in elderly patients with gastric cancer can achieve similar short and long-term outcomes as those for middle-aged patients.Age is thus not a contraindication for laparoscopic gastrectomy.