Laparoscopic D2 radical gastrectomy improves postoperative inflammation and gastric function in elderly patients with advanced gastric cancer.

Objective: To investigate the effect of laparoscopic radical gastrectomy on the inflammation and recovery of gastrointestinal function in elderly patients with advanced gastric cancer (GC).

Methods: Data of 80 elderly patients with advanced GC admitted to the Taizhou First people's Hospital from May 2014 to January 2019 were collected for this retrospective analysis. Among them, 34 patients underwent open D2 radical gastrectomy were regarded as control group. The other 46 patients underwent laparoscopic D2 radical gastrectomy were considered as observation group. Both groups underwent 2/3 or more mid-segment gastrectomy with D2 regional lymphatic dissection. The operative time, intraoperative bleeding, postoperative ventilation time, length of stay (LOS) and perioperative complication rates were compared between the two groups. Peripheral blood was drawn before and after surgery to detect the inflammatory factors C-reactive protein (CRP), calcitoninogen (PCT), tumor necrosis factor-α (TNF-α), gastric function gastrin 17 (G-17), and pepsinogen (PG) I and II. Subsequently, patients were followed up for 3-year prognosis to document the survival of patients.

Results: The operative time and LOS were shorter and intraoperative bleeding was lower in the observation group than those in the control group (P<0.05). There was no statistical difference in treatment costs and incidence of perioperative complications between the two groups (P>0.05). After surgery, CRP, PCT and TNF-α were elevated in both groups but were lower in the observation group than that in the control group (P<0.05). PG I was dramatically higher (P<0.05), while PG II and G-17 were lower (P<0.05) in both groups after treatment. Also, the posttreatment PG I and G-17 were higher (P<0.05) and PG II was lower (P<0.05) in the observation group than those in the control group. Prognostic follow-up revealed no statistical difference between groups in terms of the 1-year and 3-year overall survival (P>0.05).

Conclusion: Laparoscopic D2 radical surgery is more effective in the treatment of advanced GC in the elderly, because it can effectively suppress the postoperative inflammation and improve recovery of gastric function. Hence, it has a high clinical application value.