Laparoscopic Gastrectomy after the Age of Eighty: Still a Good Choice?

Main Goals: Evaluation and comparison of short-term results of totally laparoscopic gastrectomy performed for gastric carcinoma in two groups of patients: older and younger than eighty years. Material and Methods: From 1st January 2011 to 31st October 2012, we have treated 110 patients for gastric carcinoma. 79 patients were submitted to radical gastric resection (the remainder 31 patients either presented with cardia carcinoma or were submitted to palliative treatment). In 33 cases we performed a laparoscopic gastrectomy while in the remainder 46 cases, the open approach was used. The 33 patients operated by a laparoscopic approach were the subject of this study. They were divided in two groups: Group A—patients eighty years old or older (10 cases) and Group B—patients younger than 80 years (23 cases). We evaluated and compared the short-term outcomes of both groups. Results: In all 33 cases, a gastrectomy was performed using a totally laparoscopic approach. There was no need to convert into open surgery. No patient needed to stay in the Intensive Care Unit. One patient needed a night stay in the Post Anesthetic Care Unit, due to subcutaneous emphysema (which resolved within 24 hours). There was a fatality in Group B, due to hepatic failure. The median of the operating time was 224 minutes in Group B and 199 minutes in Group A. The difference was non-significant (pvalue > 0.05). Group A patients were discharged in 6 to 10 days while those in Group B were discharged in 6 to 9 days. Conclusion: The results in this series suggest that totally laparoscopic gastrectomy is effective and safe in patients eighty years old and older, with low morbidity and mortality and short hospital stay. It compares favourably with the results of the same technique applied to younger patients. We suggest that laparoscopic approach to gastrectomy can be used in older patients, allowing them to benefit from the advantages of minimally invasive surgery.