Propensity score-matched analysis short- and long-term outcomes of totally laparoscopic gastrectomy for gastric cancer patients with aged 80 and older

Abstract

Abstract Background: Recently, totally laparoscopic gastrectomy (TLG) has emerged as a viable treatment approach for gastric cancer (GC). However, the viability and efficacy of TLG in patients aged 80 years and older have remained uncertain. Methods: We retrospectively collected data of GC patients who underwent TLG and were performed by the same lead surgeon from August 2016 to December 2019 at the first affiliated Hospital of NingBo University in China. Propensity score matching was adopted to minimize selection bias at a ratio of 1:1 to compare the elderly group (≥80 years old, Older group) and youngerly group (＜65 years old, Younger group). Patient characteristics, tumour clinicopathologic, operative findings, short-term and 5 years-term prognosis were investigated and compared between the two groups. Results: Out of 601 GC patients, 205 met the inclusion criteria (Older group, n = 31; Younger group, n = 174). The mean age in the Older group was 83.3 ± 3.2 years, whereas in the Younger group, it was 56.5 ± 7.5 years. Following propensity score analysis, 31 patients were matched each other for further analysis. The Older group exhibited lower levels of Albumin (35.2 ± 4.2 vs 38.3 ± 5.0; p=.011), Prognostic Nutritional Index (41.4 ± 5.2 vs 51.9 ± 19.4; p=.006), NRS2002 score (Nutritional Risk Screening 2002) (4.8 ± 0.9 vs 3.7 ± 0.6; p<.001), and ASA grade (p=.004) compared to the Younger group. The Older group with a longer postoperative hospital stay (26.3 ± 15.1 vs 17.7 ± 8.6; p=0.009) and higher total medical expenses (71274.1 ± 37712.6yuan vs 54520.1 ± 17003.7yuan; p=0.029) compared with the Younger group. Except for a higher incidence of pleural effusion in the Older group compared to the Younger group (p=0.022), no significant differences in other postoperative complications were observed between the two cohorts. Furthermore, no significant differences were observed in the 1-, 3-, and 5-year overall survival (OS) rates between the two groups (p=0.345, p=0.123, p=0.345, respectively). Conclusion: TLG for GC is considered viable and effective, especially when performed by experienced teams with carefully managed patients, even in patients aged 80 years and older, resulting in satisfactory short- and long-term outcomes and offering more targeted evidence for surgical approach selection in this particular age cohort.