Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer

Table 1 Clinical and pathological characteristics of laparoscopic assisted gastrectomy and totally laparoscopic gastrectomy group for elderly patients (mean ± SD)

Characteristics	LAG group (n = 232)	TLG group (n = 230)	P value
Gender			0.472
Male	183	175
Female	49	55
Age (yr)	74.62 ± 3.80	74.69 ± 4.10	0.848
BMI (kg/m2)	23.31 ± 3.08	23.64 ± 3.46	0.285
aCCI score, n (%)			0.608
0-4	188	182
> 4	44	48
ASA score, n (%)			0.426
I	1	1
II	177	168
III	54	61
History of abdominal surgery			0.232
No	189	177
Yes	43	53
Tumor resection			0.163
Distal	125	109
Total	107	121
Neoadjuvant chemotherapy			0.201
No	223	215
Yes	9	15
Tumor diameters (cm) (median, IQR)	4.00 (2.58-6.00)	4.00 (2.65-5.5)	0.230
pT			0.895
T0	2	0
T1	38	43
T2	36	37
T3	116	107
T4	40	43
pN			0.544
N0	83	77
N1	33	33
N2	49	48
N3	67	72
pTNM			0.857
0	2	0
I	52	60
II	65	57
III	113	113
Nerve invasion			0.249
Yes	71	82
No	161	148
Vascular invasion			0.685
Yes	91	86
No	141	144
Differentiation			0.945
Well/moderate	151	149
Poor/undifferentiated	81	81

LAG: Laparoscopic assisted gastrectomy; TLG: Totally laparoscopic gastrectomy; aCCI: Age-adjusted Charlson Comorbidity Index; BMI: Body mass index; ASA: American Society of Anesthesiologists; SD: Standard deviation; IQR: Interquartile range.

Table 2 Perioperative outcomes between laparoscopic assisted gastrectomy and totally laparoscopic gastrectomy group for elderly patients (mean ± SD)

Variable	LAG group (n = 232)	TLG group (n = 230)	P value
Surgical time, min	221.34 ± 54.96	216.48 ± 52.53	0.332
Blood loss, ml (median, IQR)	100.0 (50.0-200.0)	100.0 (50.0-100.0)	0.000
Anastomotic approach
B1	17	14
B2 (+Braun)	39	36
Roux-en-Y	176	180
Retrieved lymph nodes, n	29.32 ± 11.27	30.69 ± 12.65	0.218
Extent of resection
R0	218	215
R1/R2	14	15
Time to first flatus, d	4.43 ± 1.20	3.79 ± 1.15	0.000
Postoperative day, d (median, IQR)	8.0 (7.0-10.0)	7.75 (6.0-9.0)	0.000
Total complication rate (%)	61 (26.3)	38 (16.5)	0.010
Anastomotic-related complication rate (%)	8 (3.4)	6 (2.6)	0.599
Clavien-Dindo classification
Grade II
Deep venous thrombosis	1	1
Lymphatic leakage	1	0
Gastroplegia	1	2
Anaphylaxis	1	1
Ileus	0	1
Cardiac failure	1	0
Hypoproteinemia	10	7
Anemia	12	7
Cholecystitis	2	0
Incision infection	2	1
Atrial fibrillation	4	2
Pneumonia	8	2
Anastomotic leakage	5	2
Anastomotic bleeding	0	2
Anastomotic stenosis	1	0
Duodenal trump leakage	2	1
Grade IIIa
Deep venous thrombosis	0	0
Pleural effusion	4	3
Anastomotic leakage	2	2
Duodenal trump leakage	1	1
Abdominal bleeding	0	1
Grade IV
Cardiac failure	2	0
Abdominal bleeding	1	1
Acute cerebral infarction	0	1
Severe complication rate (%)	10 (4.3)	9 (3.9)	0.830

Statistically significant P values are in bold (P < 0.05). LAG: Laparoscopic assisted gastrectomy; TLG: Totally laparoscopic gastrectomy; SD: Standard deviation; IQR: Interquartile range.

Table 3 Uni- and multivariate analysis of postoperative complications for elderly patients

Factor	Univariate analysis		P value	Multivariate analysis		P value
	OR	95%CI		OR	95%CI
Sex			0.462
Male	1.000
Female	1.215	0.724-2.038
Age (yr)			0.027			0.157
< 75	1.000			1.000
≥ 75	1.655	1.058-2.587		1.422	0.874-2.313
BMI (kg/m2)			0.321
< 25	1.000
≥ 25	0.779	0.475-1.276
Surgical approach			0.011			0.011
LAG	1.000			1.000
TLG	0.555	0.352-0.874		0.539	0.335-0.865
aCCI score			0.074			0.416
0-4	1.000			1.000
> 4	1.603	0.952-2.699		1.276	0.709-2.294
ASA score			0.030			0.069
≤ II	1.000			1.000
> II	1.713	1.055-2.783		1.626	0.963-2.744
Tumor resection			0.846
Distal	1.000
Total	0.957	0.613-1.493
Neoadjuvant chemotherapy			0.752
No	1.000
Yes	1.165	0.452-3.000
pTNM stage			0.918
0-I	1.000
II	1.072	0.571-2.012
III	1.124	0.645-1.958
Tumor diameter (cm)			0.020			0.116
≤ 3	1.000			1.000
> 3	1.815	1.101-2.995		1.535	0.900-2.618
Operation time (min)			0.031			0.039
≤ 220	1.000			1.000
> 220	1.636	1.047-2.558		1.671	1.027-2.718
Estimated blood loss (mL)			0.120			0.895
≤ 200	1.000			1.000
> 200	1.628	0.880-3.012		1.047	0.530-2.070
Vascular invasion			0.035			0.223
No	1.000			1.000
Yes	1.620	1.034-2.538		1.349	0.834-2.185
Nerve invasion			0.667
No	1.000
Yes	0.901	0.559-1.451
Differentiation			0.760
Well/moderate	1.000
Poor/undifferentiated	1.075	0.676-1.708
R0 resection			0.197			0.263
No	1.000			1.000
Yes	1.715	0.755-3.895		1.639	0.690-3.892

Statistically significant P values are in bold (P < 0.05). LAG: Laparoscopic assisted gastrectomy; TLG: Totally laparoscopic gastrectomy; aCCI: Age-adjusted Charlson Comorbidity Index; BMI: Body mass index; ASA: American Society of Anesthesiologists; OR: Odd ratio.

Table 4 Quality of life using European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire and STO-22 questionnaire between laparoscopic assisted gastrectomy and totally laparoscopic gastrectomy group

Factor	Baseline		P value	Postoperative 3 mo		P value
	LAG group	TLG group		LAG group	TLG group
QLQ-C30 questionnaire
Global status	91.6 (91.6-100)	91.6 (91.6-100)	0.096	91.6 (91.6-100)	91.6 (91.6-100)	0.934
Physical functioning	100 (93.3-100)	100 (93.3-100)	0.863	100 (93.3-100)	96.7(93.3-100)	0.777
Role functioning	100 (83.3-100)	100 (83.3-100)	0.269	100 (83.3-100)	83.3 (83.3-100)	0.804
Emotional functioning	91.6 (91.6-100)	91.6 (91.6-100)	0.343	91.6 (91.6-100)	91.6 (91.6-100)	0.880
Cognitive functioning	100 (83.3-100)	100 (83.3-100)	0.962	100 (83.3-100)	100 (83.3-100)	0.925
Social functioning	100 (83.3-100)	100 (83.3-100)	0.853	100 (83.3-100)	100 (83.3-100)	0.925
Fatigue	0 (0-0)	0 (0-0)	0.471	0 (0-0)	0 (0-11)	0.170
Nausea and vomiting	0 (0-0)	0 (0-0)	0.133	0 (0-12.5)	0 (0-0)	0.043
Pain	0 (0-0)	0 (0-0)	0.507	0 (0-0)	0 (0-0)	0.772
Dyspnea	0 (0-0)	0 (0-0)	0.165	0 (0-0)	0 (0-0)	0.880
Insomnia	0 (0-33.3)	0 (0-33.3)	0.428	0 (0-33.3)	0 (0-33.3)	0.984
Appetite loss	0 (0-0)	0 (0-33.3)	0.494	0 (0-33.3)	0 (0-33.3)	0.899
Constipation	0 (0-33.3)	0 (0-33.3)	0.529	33.3 (0-33.3)	0 (0-33.3)	0.024
Diarrhea	0 (0-0)	0 (0-0)	0.122	0 (0-0)	0 (0-0)	0.705
Financial difficulties	0 (0-33.3)	0 (0-33.3)	0.081	0 (0-33.3)	0 (0-33.3)	0.355
STO-22 questionnaire
Dysphagia	0 (0-0)	0 (0-0)	0.547	0 (0-22)	0 (0-11)	0.169
Pain	0 (0-0)	0 (0-0)	0.793	0 (0-14.6)	0 (0-8.3)	0.389
Reflux	0 (0-11)	0 (0-11)	0.444	0 (0-22)	0 (0-22)	0.548
Eating restrictions	0 (0-0)	0 (0-0)	0.441	0 (0-8.3)	0 (0-8.3)	0.848
Anxiety	0 (0-11)	0 (0-11)	0.952	0 (0-22)	0 (0-22)	0.214
Dry mouth	0 (0-0)	0 (0-0)	0.681	0 (0-0)	0 (0-0)	0.982
Taste	0 (0-0)	0 (0-0)	0.609	0 (0-0)	0 (0-0)	0.858
Body image	0 (0-0)	0 (0-0)	0.573	0 (0-33.3)	0 (0-0)	0.000
Hair loss	0 (0-0)	0 (0-0)	0.442	0 (0-0)	0 (0-0)	0.077

Statistically significant P values are in bold (P < 0.05). TLG: Totally laparoscopic gastrectomy; LAG: laparoscopic assisted gastrectomy.