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Feasibility of laparoscopic gastrectomy for elderly gastric cancer patients: meta-analysis of non-randomized controlled studies

Liang Zong, Aiwen Wu, Wenyue Wang, Jingyu Deng, Susumu Aikou, Hiroharu Yamashita, Masahiro Maeda, Masanobu Abe, Duonan Yu, Zhiwei Jiang, Yasuyuki Seto _ and Jiafu Ji

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Oncotarget. 2017; 8:51878-51887. https://doi.org/10.18632/oncotarget.16691

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Abstract

Liang Zong1,2,3, Aiwen Wu2, Wenyue Wang4, Jingyu Deng5, Susumu Aikou1, Hiroharu Yamashita1, Masahiro Maeda6, Masanobu Abe7, Duonan Yu8, Zhiwei Jiang9, Yasuyuki Seto1 and Jiafu Ji2

1 Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

2 Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China

3 Department of Gastrointestinal Surgery, Su Bei People’s Hospital of Jiangsu Province, Yangzhou University, Yangzhou, China

4 Department of Gastrointestinal Surgery, China-Japan Friendship Hospital, Beijing, China

5 Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China

6 Department of Gastrointestinal Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan

7 Division for Health Service Promotion, University of Tokyo, Tokyo, Japan

8 Institute of Comparative Medicine, Yangzhou University, Yangzhou, China

9 Research Institute of General Surgery, Jinling Hospital, Nanjing, China

Correspondence to:

Yasuyuki Seto, email:

Jiafu Ji, email:

Keywords: gastric cancer, elderly patient, laparoscopic gastrectomy, open gastrectomy, meta-analysis

Received: September 06, 2016 Accepted: March 12, 2017 Published: March 29, 2017

Abstract

The aim of this meta-analysis was to determine the feasibility of laparoscopic gastrectomy (LG) for elderly gastric cancer patients by comparing laparoscopic and conventional open gastrectomies (OG). Comprehensive search of the PubMed, EMBASE, and Cochrane Library databases revealed nine non-randomized controlled studies that compared LG and OG in elderly gastric cancer patients We then analyzed dichotomous or continuous parameters using odds ratios (ORs) or weighted mean differences (WMDs). Overall survival was estimated using hazard ratios (HRs) with a fixed effects or random effects model. We observed that the age distribution was similar between the LG and OG patient groups (WMD -0.22 95% CI, -1.26−0.82). LG patients experienced less blood loss (WMD -119.14 95% CI, -204.17−-34.11) and had shorter hospital stays (WMD -3.48 95% CI, -5.41−-1.56), but endured longer operation times (WMD 10.87 95% CI, 2.50−19.24). Postoperatively, LG patients exhibited lower incidences of postoperative morbidities (OR 0.59 95% CI, 0.43−0.79), surgery related morbidities (OR 0.58 95% CI, 0.41−0.81) and systemic morbidities (OR 0.56 95% CI, 0.38−0.82). We observed no differences between the LG and OG patient groups regarding anastomotic leakage (OR 0.69 95% CI, 0.34−1.41), mental disease (OR 0.72 95% CI, 0.37−1.41) and long term effects (HR 0.98 95% CI, 0.74−1.32). We therefore conclude that laparoscopic gastrectomy might be technically feasible for elderly gastric cancer patients.


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