腹腔镜辅助胃癌根治术对老年胃癌患者的临床疗效分析

  目的  比较老年胃癌患者和非老年患者接受腹腔镜辅助胃癌根治术后短期疗效、并发症发生情况及长期生存的差异。  方法  回顾性分析2009年4月至2013年10月就诊于北京大学肿瘤医院并接受腹腔镜辅助胃癌根治术219例患者的临床资料，比较老年组（≥65岁）与非老年组（ < 65岁）的手术情况、术后早期恢复情况及并发症发生率等，分析无病生存期和总生存期的差异。  结果  老年组术前ASA评分和合并症数目显著高于非老年组（P < 0.05），两组患者在手术时间、术中出血量、中转开腹率等方面差异无统计学意义（均P > 0.05）。老年组患者手术后平均首次下地活动时间为（2.2±2.3）d，非老年组为（1.4±1.3）d，差异具有统计学意义（P < 0.05）。两组患者之间术后并发症发生率差异无统计学意义（34.8% vs. 28.5%，P > 0.05）。3年无病生存期和总生存期两组比较差异无统计学意义（P > 0.05），但存在术后并发症的患者中，老年患者总生存率显著低于非老年患者（44.5% vs. 70.5%，P < 0.05）。  结论  腹腔镜胃癌根治术对老年患者安全可行，并且能够获得较好的长期生存，但仍需加强围手术期处理促进术后早期恢复、减少并发症发生。 

Efficacy of laparoscopy-assisted radical gastrectomy for elderly patients with gastric cancer

Objective: This study aimed to compare the short- and long-term outcomes of laparoscopy-assisted radical gastrectomy between elderly and non-elderly patients with gastric cancer. Methods: A total of 219 patients who underwent laparoscopy-assisted radical gastrectomy in the Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute from April 2009 to October 2013 were included in this retrospective study. All patients were divided into elderly (≥65 years) and non- elderly (<65 years)groups. We compared these groups based on clinicopathological characteristics, postoperative morbidities, and survival. Results:Theelderly group showed higher ASA scores and higher number of preoperative comorbidities (P<0.05). The operative time, blood loss,and conversion rate did not differ significantly between the groups (all P>0.05). The mean time to first ambulation in elderly group was 2.2±2.3d while first ambulation time in the non-elderly group was 1.4±1.3d,which showed significant difference between the two groups (P<0.05). No significant differences were observed between groups in terms of postoperativemorbidities (34.8％ vs. 28.5％, P> 0.05) as well as 3-year disease-free survival and overall survival (P>0.05). However, the elderly patients withpostoperative morbidities experienced significantly poorer overall survival rate than non-elderly patients (44.5％ vs. 70.5％, P<0.05). Conclusion: Laparoscopy-assisted gastrectomy can be safely and successfully performed in an elderly population with acceptable short- and long-term outcomes.Enhanced perioperative treatment is necessary to improve postoperative outcomes.