Low Incidence of Postoperative Pneumonia and Intra-abdominal Abscess Following Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer in Elderly Patients above 75 Years: Propensity Score Matched Comparison to Open Distal Gastrectomy

Abstract

Abstract Background: Some randomized clinical trials demonstrated that laparoscopic distal gastrectomy (LDG) is technically safe for locally advanced gastric cancer (GC) without compromising the quality of lymph node dissection. However, whether LDG can be indicated for elderly people in general practice remains to be elucidated. To the best of our knowledge, no study has compared open distal gastrectomy (ODG) and LDG for locally advanced GC in elderly patients with matched backgrounds. Therefore, this study compared the short-term outcomes of elderly patients with locally advanced GC who underwent ODG with those of patients with locally advanced GC who underwent LDG using propensity score matching analysis. Methods: A total of 341 consecutive elderly patients aged 75 years with GC who underwent ODG or LDG between January 2013 and December 2020 were retrospectively assessed. Among them, 121 patients with locally advanced GC were extracted. A 1:1 propensity score matching analysis was performed to compare short-term outcomes between ODG and LDG. Results: After matching, 35 patients were included in the ODG and LDG groups, respectively. The LDG group had a significantly longer operative time (p < 0.0001) and lesser intraoperative blood loss than the ODG group (p < 0.0001). The overall postoperative complication (Clavien–Dindo grade II or higher) rates of ODG and LDG were 37% and 9% (p = 0.003), respectively. The incidence rates of postoperative pneumonia and intra-abdominal abscess were significantly lower in patients who underwent LDG (0%) than in those who underwent ODG (9%) (p = 0.038). Furthermore, in multivariate analysis, LDG was an independent protective factor against postoperative complications (p = 0.027). Conclusions: LDG was safe and feasible for locally advanced GC in patients aged ≥ 75 years. Moreover, it may be a promising alternative to ODG with better short-term outcomes, including significantly lower incidence rates of postoperative pneumonia and intra-abdominal abscess.