Objective To investigate the factors influencing postoperative complications in patients over 70 years old who underwent laparoscopic radical gastrectomy of gastric cancer.

Methods The retrospective case-control study was conducted. The clinicopathological data of 370 gastric cancer patients over 70 years old who were admitted to 10 medical centers, including Tianjin Medical University Cancer Institute & Hospital et al, from January 2020 to December 2022 were collected. There were 281 males and 89 females, aged (74±4)years. All patients were divided into the patients with postoperative complications and the patients without postoperative complications, respectively. Observation indicators: (1) implementation of laparoscopic radical gastrectomy in gastric cancer patients over 70 years old; (2) surgical conditions of gastric cancer patients over 70 years old who underwent laparoscopic radical gastrectomy; (3) analysis of factors influencing postoperative com-plications in gastric cancer patients over 70 years old who underwent laparoscopic radical gastrectomy. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi‑square test. Comparison of ordinal data was conducted using the non‑parameter rank sum test. Univariate analysis was conducted using corresponding methods based on data types. Multivariate analysis was conducted using the Logistic regression model.

Results (1) Implementation of laparoscopic radical gastrectomy in gastric cancer patients over 70 years old. Of the 370 gastric cancer patients over 70 years old who were admitted from 2020 to 2022, there were 212 cases undergoing total laparos-copic gastrectomy, and 158 cases undergoing laparoscopic assisted radical gastrectomy, respectively. In 2020, among 63 patients who underwent laparoscopic radical gastrectomy for gastric cancer, the proportion of totally laparoscopic radical gastrectomy was 41.27%(26/63). In 2021, among 133 patients who underwent laparoscopic radical gastrectomy for gastric cancer, the proportion of totally laparos-copic radical gastrectomy was 54.14%(72/133). In 2022, among 174 patients who underwent lapa-roscopic radical gastrectomy for gastric cancer, the proportion of totally laparoscopic radical gastrec-tomy was 65.52%(114/174). (2) Surgical conditions of gastric cancer patients over 70 years old who underwent laparoscopic radical gastrectomy. The operation time, number of lymph node dissected, number of metastatic lymph node of 370 gastric cancer patients over 70 years old were (221±82)minutes, 30(range, 5-85), 2(range, 0-76). Of the 370 patients, there were 326 cases receiving D₂ lymph node dissection, and 44 cases receiving D₁ or D₁₊ lymph node dissection. There were 360 cases achieved R₀ resection, and 10 cases achieved R₁ resection. There were 99 patients experienced postoperative complications, including 42 cases of ≥grade 3 complications. There were 6 cases undergoing secon-dary surgery due to complications, and 4 cases died during the perioperative period. Results of post-operative pathological staging in 370 patients showed there were 90 cases in stage Ⅰ, 66 cases in stage Ⅱ,205 cases in stage Ⅲ, and 9 cases in stage Ⅳ. (3) Analysis of factors influencing postoperative complications in gastric cancer patients over 70 years old who underwent laparoscopic radical gastrec-tomy. Results of multivariate analysis showed that gender, American Society of Anesthesiologists (ASA) score, range of lymph node dissection, operation time were independent factors affecting postoperative complications in gastric cancer patients over 70 years old who underwent laparoscopic radical gastrectomy (hazard ratio=0.449, 2.088, 5.184, 2.646, 95% confidence interal as 0.234-0.859, 1.059-4.119, 1.522-17.654, 1.564-4.477, P<0.05).

Conclusion Gender, ASA score, range of lymph node dissection and operation time are independent factors affecting postoperative complications in gastric cancer patients over 70 years old who underwent laparoscopic radical gastrectomy.