| Objective:To explore the feasibility, safety and efficacy of the laparoscope-assisted radical gastrectomy for gastric cancer which used in older than 70-year-old advanced gastric cancer patients.Methods:A total of 117 gastric cancer patients underwent laparoscopic radical gastrectomy were studied at Fujian Province Tumor Hospital Affiliated to Fujian Medical University between January 2009 and December 2015.They were divided into two groups. One of them were older than 75-year-old(elder group), the others were 35 to 65 years old(young group). 78 cases advanced gastric cancer patients randomly selected as control group who were older than 75-year-old and chosen laparotomy operation. Three groups of patients had complete follow-up data. The date was summarized retrospectively analyzed and carried on the statistical analysis to each group. These date included patient's age, gender,having preoperative complications or not, tumor site, infiltration depth, the number of regional lymph node metastasis, clinical stage, pathological differentiation degree,operation method, the range of gastric resection surgery, postoperative complications,intraoperative blood loss, operative time, postoperative anal exhaust time, postoperative eating liquid for the first time, postoperative hospitalization days. Then we can sum up the clinical characteristics of elderly patients with gastric cancer, comparison between groups of recent curative effect, and the feasibility, safety and short-term curative effect on laparoscopic gastric cancer radical in elder patients with advanced gastric cancer.Results:(1) In the elder group, the proportion of male and preoperative complications is higher, more tumors located in the upper stomach, and nature of the tumor is mainly in poorly differentiated adenocarcinoma. In the young group, the location of the tumor wasmainly at lower part of the stomach.(2) Compared with elder age of open group, the elder laparoscopic group had shorten incision length and the operation time(P = 0.000). The first exhaust and eating liquid were earlier than the elder open group. And the postoperative hospitalization days were shorter(P < 0.05). But, in these two groups, the lymph node in the intraoperative blood loss, postoperative complications in no statistically significant difference(P > 0.05).(3) Compared with younger Laparoscopic group, the operative time in the elder laparoscopic group were significantly prolonged(P= 0.021), the intraoperative blood loss was significantly increased(P = 0.007), but in the number of lymph node cleaning, incision length, exhaust time, eating liquid time,postoperative hospitalization days and the difference in the postoperative complications,no statistical significance(P > 0.05).(4) Two or more kinds of preoperative complications were independent risk factors of the probability of occurrence for postoperative complications in patients. It can have a 3.2-fold increased risk of postoperative complications. Removed the interference of preoperative complications, there was no statistical significance in the probability of occurrence of postoperative complications between elder and young laparoscopic group(P = 1.000).Conclusion:(1) Before laparoscopic surgery, we need to make a comprehensive evaluation before operation,have proper management of preoperative complications, select the suitable case and strengthen perioperative nursing. It not only can make the patients improve the tolerance ability, and can obtain satisfactory short-term efficacy;(2) The short-term curative effect is satisfactory in the laparoscopic treatment of elder gastric cancer. And it has small abdominal incision, faster recovery of gastrointestinal function, and short postoperative hospital stay. |
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