Short-term outcomes and prognosis of laparoscopy-assisted total gastrectomy in elderly patients with stomach cancer



The aim of this study was to evaluate the short-term outcomes and prognosis of laparoscopy-assisted total gastrectomy (LTG) in elderly patients with gastric cancer.


The clinical data of 275 patients aged over 65 years undergoing open total gastrectomy (OTG, n = 184) or laparoscopy-assisted total gastrectomy (LTG, n = 91) were reviewed from January 2015 to August 2017 at the First Affiliated Hospital of the University of Science and Technology of China. Short-term outcomes were compared between the two groups, and risk factors for postoperative complications were explored. In addition, the 2-year overall survival (OS) and disease-free survival (DFS) were investigated for both groups.


Except for the ASA score (P = 0.01), there was no significant difference regarding patient baselines between the two groups. Patients in the LTG group had a longer operative time (P < 0.001), less intraoperative blood loss (P = 0.004), a shorter time of resumption to a semi-liquid diet (P < 0.001) and a shorter postoperative hospital stay (P = 0.001). The incidence of pulmonary complications was significantly lower in the LTG group than in the OTG group (4.4% vs. 13%, P = 0.026). The number of lymph nodes harvested in the LTG group was higher than that in the OTG group (20.7 ± 7.4 vs. 17.5 ± 6.9, P = 0.001), and the proportion of patients with TNM stage III gastric cancer was higher in the LTG group than in the OTG group (P = 0.035). There was no significant difference in the 2-year OS rate or 2-year DFS rate between the two groups (P = 0.057 and P = 0.344). Sex, age, preoperative comorbidity, intraoperative blood loss, and TNM stage were identified as independent prognostic factors for postoperative survival.


Comparing with OTG, LTG is feasible and contributes to less surgical trauma and a faster recovery after total gastrectomy. In addition, LTG contributes to a lower risk of postoperative pulmonary complications. Regarding oncological results, LTG is more effective for lymph node dissection and has a comparable long-term prognosis as OTG.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Balakrishnan M, George R, Sharma A, Graham DY (2017) Changing trends in stomach cancer throughout the world. Curr Gastroenterol Rep 19(8):36

    Google Scholar 

  2. 2.

    Rahman R, Asombang AW, Ibdah JA (2014) Characteristics of gastric cancer in Asia. World J Gastroenterol 20(16):4483–4490

    Google Scholar 

  3. 3.

    Strong VE, Wu AW, Selby LV et al (2015) Differences in gastric cancer survival between the U.S. and China. J Surg Oncol 112(1):31–37

    Google Scholar 

  4. 4.

    Chen W, Zheng R, Zhang S, Zhao P, Zeng H, Zou X (2014) Report of cancer incidence and mortality in China, 2010. Ann Transl Med 2(7):61

    CAS  Google Scholar 

  5. 5.

    Yang L, Zheng R, Wang N et al (2018) Incidence and mortality of stomach cancer in China, 2014. Chin J Cancer Res 30(3):291–298

    Google Scholar 

  6. 6.

    Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y (2002) Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years' experience. Surg Laparosc Endosc Percutan Tech 12(3):204–207

    Google Scholar 

  7. 7.

    Goh PM, Khan AZ, So JB et al (2001) Early experience with laparoscopic radical gastrectomy for advanced gastric cancer. Surg Laparosc Endosc Percutan Tech 11(2):83–87

    CAS  Google Scholar 

  8. 8.

    Yoo MW, Han HS, Han DS (2014) Comparison of the counts of station-specific lymph nodes retrieved in laparoscopy-assisted distal gastrectomy of early experience with those in open distal gastrectomy. J Laparoendosc Adv Surg Tech Part A 24(11):777–781

    Google Scholar 

  9. 9.

    Yoshida K, Honda M, Kumamaru H et al (2018) Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: a retrospective cohort study based on a nationwide registry database in Japan. Ann Gastroenterol Surg 2(1):55–64

    Google Scholar 

  10. 10.

    Zheng L, Lu L, Jiang X, Jian W, Liu Z, Zhou D (2016) Laparoscopy-assisted versus open distal gastrectomy for gastric cancer in elderly patients: a retrospective comparative study. Surg Endosc 30(9):4069–4077

    Google Scholar 

  11. 11.

    Li Q, Wang J, Zhang G, Wang J, Yang B, Zhang Z (2016) Feasibility and safety comparison of laparoscopy-assisted versus open gastrectomy for advanced gastric carcinoma with D2 lymphadenectomy. Jpn J Clin Oncol 46(4):323–328

    Google Scholar 

  12. 12.

    Lianos GD, Rausei S, Dionigi G, Boni L (2016) Assessing safety and feasibility of minimally invasive surgical approaches for advanced gastric cancer. Future Oncol 12(1):5–8

    CAS  Google Scholar 

  13. 13.

    Lee JH, Nam BH, Ryu KW et al (2016) Comparison of the long-term results of patients who underwent laparoscopy versus open distal gastrectomy. Surg Endosc 30(2):430–436

    Google Scholar 

  14. 14.

    Wang W, Chen K, Xu XW, Pan Y, Mou YP (2013) Case-matched comparison of laparoscopy-assisted and open distal gastrectomy for gastric cancer. World J Gastroenterol 19(23):3672–3677

    Google Scholar 

  15. 15.

    Takiguchi S, Fujiwara Y, Yamasaki M, et al. Laparoscopy-assisted distal gastrectomy versus open distal gastrectomy. A prospective randomized single-blind study. World J Surg 2013; 37(10): 2379–86.

  16. 16.

    Jung HS, Park YK, Ryu SY, Jeong O (2015) Laparoscopic total gastrectomy in elderly patients (%3e/=70 years) with gastric carcinoma: a retrospective study. J Gastric Cancer 15(3):176–182

    Google Scholar 

  17. 17.

    Lu J, Huang CM, Zheng CH et al (2015) Short- and long-term outcomes after laparoscopic versus open total gastrectomy for elderly gastric cancer patients: a propensity score-matched analysis. J Gastrointest Surg 19(11):1949–1957

    Google Scholar 

  18. 18.

    Sheng S, Chen Y, Li C (2018) Outcomes of laparoscopic total gastrectomy for elderly gastric cancer patients. J Cancer 9(23):4398–4403

    Google Scholar 

  19. 19.

    Li Z, Bai B, Ji G, Li J, Zhao Q (2018) Relationship between Clavien-Dindo classification and long-term survival outcomes after curative resection for gastric cancer: a propensity score-matched analysis. Int J Surg 60:67–73.

    Article  Google Scholar 

  20. 20.

    Pal SK, Katheria V, Hurria A (2010) Evaluating the older patient with cancer: understanding frailty and the geriatric assessment. CA Cancer J Clin 60(2):120–132

    Google Scholar 

  21. 21.

    Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS (1997) Measuring prognosis and case mix in hospitalized elders. The importance of functional status. J Gen Intern Med 12(4):203–208

    CAS  Google Scholar 

  22. 22.

    Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J (1998) Importance of functional measures in predicting mortality among older hospitalized patients. JAMA 279(15):1187–1193

    CAS  Google Scholar 

  23. 23.

    Klein BE, Klein R, Knudtson MD, Lee KE (2005) Frailty, morbidity and survival. Arch Gerontol Geriatr 41(2):141–149

    Google Scholar 

  24. 24.

    Walter LC, Brand RJ, Counsell SR et al (2001) Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 285(23):2987–2994

    CAS  Google Scholar 

  25. 25.

    Nunobe S, Hiki N, Fukunaga T et al (2007) Laparoscopy-assisted pylorus-preserving gastrectomy: preservation of vagus nerve and infrapyloric blood flow induces less stasis. World J Surg 31(12):2335–2340

    Google Scholar 

  26. 26.

    Hiki N, Shimoyama S, Yamaguchi H, Kubota K, Kaminishi M (2006) Laparoscopy-assisted pylorus-preserving gastrectomy with quality controlled lymph node dissection in gastric cancer operation. J Am Coll Surg 203(2):162–169

    Google Scholar 

  27. 27.

    Luo J, Zhu Y, Liu H et al (2018) Morbidity and mortality of elderly patients with advanced gastric cancer after laparoscopy-assisted or open distal gastrectomy: a randomized-controlled trial. Gastroenterol Rep 6(4):317–319

    Google Scholar 

  28. 28.

    Aratani K, Sakuramoto S, Chuman M et al (2018) Laparoscopy-assisted distal gastrectomy for gastric cancer in elderly patients: surgical outcomes and prognosis. Anticancer Res 38(3):1721–1725

    Google Scholar 

  29. 29.

    Anegawa G, Nakashima Y, Fujinaka Y, Takahashi I (2016) Laparoscopy-assisted distal gastrectomy for early gastric cancer poses few limitations for selected elderly patients: a single-center experience. Surg Case Rep 2(1):56

    Google Scholar 

  30. 30.

    Miyasaka Y, Nabae T, Yanagi C et al (2014) Laparoscopy-assisted distal gastrectomy for the eldest elderly patients with gastric cancer. Hepato-Gastroenterol 61(132):1133–1137

    Google Scholar 

  31. 31.

    Honda M, Kumamaru H, Etoh T et al (2018) Surgical risk and benefits of laparoscopic surgery for elderly patients with gastric cancer: a multicenter prospective cohort study. Gastric Cancer 11(10):018–0898

    Google Scholar 

  32. 32.

    Evans C, Galustian C, Kumar D et al (2009) Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors. Am J Surg 197(2):238–245

    CAS  Google Scholar 

  33. 33.

    Yoshida M, Koga S, Ishimaru K et al (2017) Laparoscopy-assisted distal gastrectomy is feasible also for elderly patients aged 80 years and over: effectiveness and long-term prognosis. Surg Endosc 31(11):4431–4437

    Google Scholar 

  34. 34.

    Lebowitz P, Yedlin A, Hakimi AA, Bryan-Brown C, Richards M, Ghavamian R (2015) Respiratory gas exchange during robotic-assisted laparoscopic radical prostatectomy. J Clin Anesth 27(6):470–475

    Google Scholar 

  35. 35.

    Schulte-Steinberg H, Meyer G, Forst H. Are high risk patients candidates for minimally invasive surgery with CO2 pneumoperitoneum? Viewpoint from anesthesiology. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 1996; 67(1): 72–6.

  36. 36.

    Matsuzaki S, Jardon K, Maleysson E, D'Arpiany F, Canis M, Botchorishvili R (2012) Impact of intraperitoneal pressure of a CO2 pneumoperitoneum on the surgical peritoneal environment. Hum Reprod 27(6):1613–1623

    CAS  Google Scholar 

  37. 37.

    Smith DD, Schwarz RR, Schwarz RE (2005) Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol 23(28):7114–7124

    Google Scholar 

  38. 38.

    Etoh T, Shiraishi N, Kitano S (2005) Laparoscopic gastrectomy for cancer. Dig Dis 23(2):113–118

    Google Scholar 

  39. 39.

    Lee SW, Tanigawa N, Nomura E et al (2012) Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol 10:267

    Google Scholar 

  40. 40.

    Lee HW, Kim HI, An JY et al (2011) Intracorporeal anastomosis using linear stapler in laparoscopic distal gastrectomy: comparison between gastroduodenostomy and gastrojejunostomy. J Gastric Cancer 11(4):212–218

    Google Scholar 

  41. 41.

    Chen XZ, Wen L, Rui YY et al (2015) Long-term survival outcomes of laparoscopic versus open gastrectomy for gastric cancer: a systematic review and meta-analysis. Medicine 94(4):e454

    Google Scholar 

  42. 42.

    Shen H, Shan C, Liu S, Qiu M (2013) Laparoscopy-assisted versus open total gastrectomy for gastric cancer: a meta-analysis. J Laparoendosc Adv Surg Techn Part A 23(10):832–840

    Google Scholar 

  43. 43.

    Shu B, Lei S, Li F, Hua S, Chen Y, Huo Z (2016) Laparoscopic total gastrectomy compared with open resection for gastric carcinoma: a case-matched study with long-term follow-up. J BUON 21(1):101–107

    Google Scholar 

  44. 44.

    Kim HH, Han SU, Kim MC et al (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 32(7):627–633

    Google Scholar 

Download references


This project was funded by the National Natural Science Foundation of China (81501601) and the Natural Science Foundation of An Hui Province of China (1608085QH198).

Author information




DLL, LL and ZQZ were involved in the study conception and design. DLL, LL and XW performed the data acquisition. DLL, LCL and SJL performed the analysis and interpretation of the data. DLL, LH, and YRH drafted the manuscript. DLL, YF and ZQZ critically revised the manuscript.

Corresponding authors

Correspondence to Liu Liu or Zhiqiang Zhu.

Ethics declarations


Dongliang LIU, Lichuan LIANG, Liu LIU, Zhiqiang ZHU, Shaojun LIU, Lei HU, Yiren HE, Yu FANY, Xiao WAN have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 15 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liu, D., Liang, L., Liu, L. et al. Short-term outcomes and prognosis of laparoscopy-assisted total gastrectomy in elderly patients with stomach cancer. Surg Endosc 34, 5428–5438 (2020).

Download citation


  • Elderly patients
  • Laparoscopy-assisted surgery
  • Open surgery
  • Total gastrectomy
  • Gastric cancer