Short- and Long-Term Advantages of Laparoscopic Gastrectomy for Elderly Patients with Locally Advanced Cancer.

Simple Summary: The aging population has led to an increase in elderly patients with locally advanced gastric cancer (LAGC) requiring in-hospital care. These patients often present with higher levels of comorbidity and frailty, due to reduced physiological reserve and functional capacity, with a major susceptibility to surgery-related complications. However, the adoption of specific ERAS guidelines on gastric cancer surgery for elderly patients has been proven safe and effective, leading to optimize hospital stay and costs with equal complication rates. Prehabilitation programs also improve pre-treatment patient function, potentially enhancing their capacity to tolerate multimodal therapy. This study explores whether elderly patients affected by LAGC following an ERAS-based protocol may benefit from laparoscopic procedures, which could reduce operative stress and possibly improve survival in frail individuals. Minimally invasive surgery has provided several clinical advantages in locally advanced gastric cancer (LAGC) care, although a consensus on its application criteria remains unclear. Surgery remains a careful choice in elderly patients, who frequently present with frailty, comorbidities, and other disabling diseases. This study aims to assess the possible advantages of laparoscopic gastric resections in elderly patients presenting with LAGC. This retrospective study analyzed a single-center series of elderly patients (≥75 years) undergoing curative resections for LAGC between 2015 and 2020. A comparative analysis of open versus laparoscopic approaches was conducted, focusing on postoperative complications, length of hospital stay (LOS), and long-term survival. A total of 62 patients underwent gastrectomy through an open or a laparoscopic approach (31 pts each). The study population did not show statistically significant differences in demographics, operative risk, and neoadjuvant chemotherapy. The laparoscopic group reported significantly minimized overall complications (45.2 vs. 71%, p = 0.039) and pulmonary complications (0 vs. 9.7%, p = 0.038) as well as a shorter LOS (8 vs. 12 days, p = 0.007). Lymph node harvest was equal between the groups, although long-term overall survival presented significantly better after laparoscopic gastrectomy (p = 0.048), without a relevant difference in terms of disease-free and disease-specific survivals. Laparoscopic gastrectomy proves effective in elderly LAGC patients, offering substantial short- and long-term postoperative benefits. [ABSTRACT FROM AUTHOR]