Possible muscle-sparing advantage and bodyweight maintenance of laparoscopic gastrectomy for older patients with locally advanced gastric cancer.

[PURPOSE] Laparoscopic gastrectomy (LG) is a promising approach for older patients who require less invasive surgery because of their reduced functional reserve and increased comorbidities, with the expansion of its indication to locally advanced gastric cancer. However, the specific benefits of LG in older patients remain unclear. We evaluated whether LG positively influences the postoperative maintenance of skeletal muscle (SM) and bodyweight (BW).

[METHODS] We retrospectively analyzed the data of consecutive patients aged ≥ 75 years who underwent open gastrectomy (OG) and LG for cStage II or III gastric cancer between 2016 and 2021. After adjustment using propensity score matching, surgical and postoperative outcomes were compared between the groups including the postoperative changes of SM index (%SMI) and BW (%BW).

[RESULTS] A total of 167 patients who underwent OG (n = 93) and LG (n = 74) were included in the study. After matching, 48 patients in each group were eligible. No significant difference in postoperative complications was observed. Both %SMI and %BW after LG were significantly maintained compared with those after OG during the postoperative first year. LG had consistently positive effects on the maintenance of %SMI and %BW across the prespecified subgroups. Notably, patients with body mass index < 25, performance status 0-1, non-total gastrectomy, and absence of adjuvant chemotherapy benefited from LG in the maintenance of %SMI and %BW.

[CONCLUSION] LG offers greater advantages over OG in maintaining postoperative SM mass as well as BW in patients aged ≥ 75 with locally advanced gastric cancer.