Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2015

01-05-2015 | Gastrointestinal Oncology

Carbon Dioxide Pneumoperitoneum Led to No Severe Morbidities for the Elderly During Laparoscopic-Assisted Distal Gastrectomy

Authors: Satoshi Suzuki, MD, PhD, Tetsu Nakamura, MD, PhD, Tatsuya Imanishi, MD, PhD, Shingo Kanaji, MD, PhD, Masashi Yamamoto, MD, PhD, Kiyonori Kanemitsu, MD, PhD, Kimihiro Yamashita, MD, PhD, Yasuo Sumi, MD, PhD, Kenichi Tanaka, MD, PhD, Daisuke Kuroda, MD, PhD, Yoshihiro Kakeji, MD, PhD

Published in: Annals of Surgical Oncology | Issue 5/2015

Login to get access

Abstract

Background

Our purpose was to evaluate the perioperative safety of laparoscopic-assisted distal gastrectomy (LADG) in elderly patients with clinical stage I gastric cancer.

Methods

From 527 consecutive patients who underwent distal gastrectomy for gastric cancer from 2000 to 2011, 38 elderly patients (aged 75 years or older) with clinical stage I disease who underwent LADG were compared with 28 elderly patients who underwent open distal gastrectomy (ODG) and with 41 nonelderly patients (younger than aged 65 years) who underwent LADG. Intraoperative cardiopulmonary changes following pneumoperitoneum and surgical outcomes were analyzed.

Results

A significant elevation in mean blood pressure (MAP) (by 44 %) and slight increase in heart rate (HR) (by 13 %) were observed 5 min after the beginning of pneumoperitoneum in the elderly LADG group, although they tended to remain stable since 30 min. The elevation of end-tidal CO2 (ETCO2) in the elderly LADG group remained at 8 % and did not differ from that in the nonelderly LADG group who were 20.5 years (median) younger, whereas percutaneous oxygen saturation (SpO2) did not worsen. Compared with the elderly ODG group, the elderly LADG group did not increase intraoperative cardiopulmonary impairment or complication, had lower incidence of postoperative medical complication (7.9 vs. 32.1 %, p = 0.012) and shortened postoperative recovery course (25 vs. 15 days, p < 0.001). Pneumoperitoneum did not necessarily impair cardiopulmonary dynamics or prognosis for elderly patients with declining cardiopulmonary function.

Conclusions

Cardiopulmonary impairment caused by pneumoperitoneum was not critical but transitory. LADG led to superior perioperative course for elderly patients with early gastric cancer.
Literature
1.
Siegel R, Naishadham D, Jemal A. Global cancer statistics. Cancer J Clin. 2013;63:11–30.CrossRef
2.
3.
Damhuis RA, Tilanus HW. The influence of age on resection rates and postoperative mortality in 2773 patients with gastric cancer. Eur J Cancer. 1995;31A:928–31.CrossRefPubMed
4.
Kitamura K, Sugimachi K, Saku M. Evaluation of surgical treatment for patients with gastric cancer who are over 80 years of age. Hepatogastroenterology. 1999;46:2074–80.PubMed
5.
Japan Society for Endoscopic Surgery. 11th Nationwide Survey of Endoscopic Surgery in Japan. J Jpn Soc Endosc Surg. 2012;17:571–694.
6.
Kitano S, Shiraishi N, Fujii K, et al. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306–11.CrossRefPubMed
7.
Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report- a phase III multicenter, prospective, randomized trial (KLASS trial). Ann Surg. 2010;251:417–20.CrossRefPubMed
8.
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;37:2379–86.CrossRefPubMed
9.
Kunisaki C, Makino H, Takagawa R, et al. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc. 2009;23:377–83.CrossRefPubMed
10.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRef
11.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedCentralPubMed
12.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guideline 2010 (ver. 3). Gastric Cancer. 2010;14:113–23.CrossRef
13.
Tokunaga M, Hiki N, Fukunaga T, Miki A, Ohyama S, Seto Y, Yamaguchi T. Does age matter in the indication for laparoscopy-assisted gastrectomy? J Gastrointest Surg. 2008;12:1502–7.CrossRefPubMed
14.
Cho GS, Kim W, Kim HH, Ryu SW, Kim MC, Ryu SY. Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg. 2009;96:1437–42.CrossRefPubMed
15.
Sharma KC, Brandstetter RD, Brensilver JM, Jung LD. Cardiopulmonary physiology and pathophysiology as a consequence of laparoscopic surgery. Chest. 1996;110:810–5.CrossRefPubMed
16.
Schulze S, Lyng KM, Bugge K, et al. Cardiovascular and respiratory changes and convalescence in laparoscopic colonic surgery. Arch Surg. 1999; 134:1112–8.CrossRefPubMed
17.
Harris SN, Ballantyne GH, Luther MA, Perrino AC. Alterations of cardiovascular performance during laparoscopic colectomy: a combined hemodynamic and echocardiographic analysis. Anesth Analg. 1996;83:482–7.PubMed
18.
Galizia G, Prizio G, Lieto E, et al. Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum, and abdominal wall-lifting cholecystectomy: a prospective, randomized study. Surg Endosc. 2001;15:477–83.CrossRefPubMed
19.
Senagore AJ, Whalley D, Delancy CP, Mekhail N, Duepree HJ, Fazio VW. Epidural anesthesia–analgesia shortens length of stay after laparoscopic colectomy for benign pathology. Surgery. 2001;129:672–6.CrossRefPubMed
Metadata
Title
Carbon Dioxide Pneumoperitoneum Led to No Severe Morbidities for the Elderly During Laparoscopic-Assisted Distal Gastrectomy
Authors
Satoshi Suzuki, MD, PhD
Tetsu Nakamura, MD, PhD
Tatsuya Imanishi, MD, PhD
Shingo Kanaji, MD, PhD
Masashi Yamamoto, MD, PhD
Kiyonori Kanemitsu, MD, PhD
Kimihiro Yamashita, MD, PhD
Yasuo Sumi, MD, PhD
Kenichi Tanaka, MD, PhD
Daisuke Kuroda, MD, PhD
Yoshihiro Kakeji, MD, PhD
Publication date
01-05-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 5/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4182-8

Other articles of this Issue 5/2015

Annals of Surgical Oncology 5/2015 Go to the issue

Breast Oncology

Pathological Complete Response in Neoadjuvant Treatment of Breast Cancer

Breast Oncology

Implications of HER2-Targeted Therapy on Extent of Surgery for Early-Stage Breast Cancer

Neuro-Oncology

Versatility of Percutaneous Pedicular Screw Fixation in Metastatic Spine Tumor Surgery: A Prospective Analysis

Breast Oncology

Impact of Neoadjuvant Chemotherapy on Locoregional Surgical Treatment of Breast Cancer

Colorectal Cancer

Histologic Categorization of Desmoplastic Reaction: Its Relevance to the Colorectal Cancer Microenvironment and Prognosis

Gastrointestinal Oncology

Moving Fast and Moving Slow