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Page 2 of 9 Yuu et al. Mini-invasive Surg 2019;3:6 I http://dx.doi.org/10.20517/2574-1225.2018.73

INTRODUCTION
In Japan, the 2017 Annual Health, Labour and Welfare Report defined an “elderly” or older person as an
individual aged 75 years or older. The average age of the population and the number of elderly patients
[1]
have been increasing worldwide, particularly in developing countries . Elderly patients usually have
[2,3]
various comorbidities such as cardiovascular diseases and decreased respiratory function, making them
unsuitable for surgery. Age exceeding 70 years is an independent predictor of increased postoperative
[4-6]
complications, in-hospital mortality, and longer hospital stays .

The advantages of laparoscopic surgery demonstrated by several reports include a decreased morbidity
[7-9]
rate, decreased pain, and faster recovery . It is important to determine whether elderly patients with
advanced gastric cancer can benefit from laparoscopic surgery. However, few studies on laparoscopic distal
gastrectomy (LDG) in elderly patients, especially those with advanced gastric cancer, have been reported.
Therefore, it is necessary to study the safety, efficacy, and outcomes of LDG in elderly patients with
advanced gastric cancer. Although several studies have reported the safety and benefits of laparoscopic
surgery for gastric cancer in the elderly, most authors preferred to compare the findings in the elderly
with those in younger patients [10,11] . These researchers could not illustrate that the laparoscopic surgery for
gastric cancer in elderly patients were more effective and safe than traditional open surgery. Therefore, the
present study aimed to compare the surgical and early postoperative outcomes of LDG with those of open
distal gastrectomy (ODG) for advanced gastric cancer in patients age 75 years or older.

METHODS
[12]
We identified 60 patients aged 75 years or older who underwent LDG or ODG for advanced primary
gastric cancer at the Department of Surgery of Bell Land General Hospital from October 2010 to October
2017. The patients were retrospectively selected from a prospectively collected database and divided into
two groups based on the operative approach: the LDG group and the ODG control group.

Exclusion criteria included urgent or emergent procedures and operations other than distal gastrectomy,
such as total or proximal gastrectomy. Preoperative diagnosis was made by upper endoscopy with tumor
biopsy, and clinical staging was performed with abdominopelvic computed tomography. Tumors were
[12]
staged according to the Japanese Classification of Gastric Carcinoma .

In this study, laparoscopic surgery was performed by three surgeons who were proven experts in their
field as defined by the Japan Society for Endoscopic Surgery. Two of the three surgeons are experts in
laparoscopic gastrectomy. The indications for LDG and ODG were the same: clinically diagnosed gastric
cancer without distant metastasis and lymph node involvement in the extraperigastric area. The patients
were fully informed of their diagnoses and briefed on whether they would undergo LDG or ODG. The
choice of LDG or ODG was decided upon by the patient and the attending surgeon after discussing both
approaches. Written informed consent was obtained from all patients before the operation.

Data on several factors, including preoperative patient baseline parameters, perioperative variables,
postoperative outcomes, and pathologic results, were collected for analysis. The preoperative parameters
analyzed were age, sex, body mass index (BMI), American Society of Anesthesiology (ASA) classification,
previous abdominal surgery, and comorbidities, which were assessed using the Charlson Comorbidity
[13]
Index (CCI) . Perioperative variables analyzed included the mode of anastomosis, length of the operation,
estimated blood loss, time to first oral diet, and duration of postoperative hospital stay. Postoperative
outcomes included postoperative complications, 30-day mortality, and recurrences. Postoperative
complications, such as anastomotic leakage and pancreatic fistula, were classified based on the Clavien-
[14]
Dindo classification . In addition, postoperative complications such as pneumonia and delirium, which