Ann Surg Treat Res.  2025 Feb;108(2):86-92. 10.4174/astr.2025.108.2.86.

Enhanced recovery after laparoscopic distal gastrectomy using articulating laparoscopic instruments in older adults with gastric cancer: a retrospective analysis of prospectively collected data

• Choi S
• Kinoshita T
• Obama K
• Sakurai K
• Kubo N
• Ikoma N
• Guner A
• Kim HI

• KMID: 2564247
• DOI: http://doi.org/10.4174/astr.2025.108.2.86

Abstract

Purpose
As the number of older adults with gastric cancer requiring gastrectomy has increased, it has become increasingly important to use techniques that enhance surgical safety and reduce postoperative complications in this vulnerable patient population. Articulating laparoscopic instruments (ALIs) may improve maneuverability and precision, leading to better outcomes in older patients. This study aimed to compare postoperative outcomes of older adults undergoing laparoscopic distal gastrectomy for gastric cancer using conventional versus ALIs.
Methods
This retrospective study included 147 older patients (aged ≥70 years) who underwent laparoscopic distal gastrectomy for gastric cancer between 2017 and 2024. Surgery was performed using conventional laparoscopic instruments in 61 patients and ALIs in 86 patients. The median follow-up period was 20 months.
Results
Postoperative hospital stay was significantly shorter in the articulating group than in the conventional group (4.6 ± 2.0 days vs. 5.4 ± 2.4 days, P = 0.030). Time to first flatus was also significantly shorter in the articulating group (2.4 ± 0.7 days vs. 2.8 ± 1.0 days, P = 0.022). However, there were no significant differences in overall complications, major (≥grade III) complications (conventional, 1.2% vs. articulating, 0%; P = 0.398) overall survival, or recurrence-free survival between groups.
Conclusion
The use of articulating instruments in older adults undergoing laparoscopic distal gastrectomy for gastric cancer was associated with shorter postoperative hospital stays and faster recovery of bowel function, with no apparent detrimental effects on complications, recurrence, or survival. These findings suggest that ALIs enhance recovery and possibly overall surgical outcomes in this patient population.

Keyword

Gastrectomy; Laparoscopy; Surgical Instruments

Figure

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  Fig. 1 Kaplan-Meier survival curves of older adults after laparoscopic distal gastrectomy for gastric cancer using either conventional or articulating instruments. (A) Overall survival, (B) recurrence-free survival.

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