Laparoscopic Versus Open Gastrectomy for Elderly Local Advanced Gastric Cancer Patients

Inclusion Criteria:

• Ambulatory male or female aged 70 and above

• Karnofsky score≥70%

• Histologically proven gastric adenocarcinoma in biopsy (including Laurenclassification) Proven clinical stage of cT2-4aNanyM0 by baseline ultrasoundendoscope, enhanced CT/MRI examination, or diagnostic laparoscopy using HabermannStandards

• No past chemotherapy or radiotherapy before diagnosis

• Primary tumor located at stomach, achievable naked-eye complete resection (R0/1) viadistal subtotal or total gastrectomy plus lymphadenectomy

• Haematology and biochemistry index meet the following: hemoglobin≥80g/L, absoluteneutrophils count (ANC)≥1.5×109/L, platelet≥100×109/L, ALT、AST≤2.5 times the upperlimit of normal value, ALP≤2.5 times the upper limit of normal value, serum totalbilirubin<1.5 times the upper limit of normal value, serum creatinine<1 times theupper limit of normal value, serum albumin≥30g/L

• Heart and lung function can withstand surgery

• No severe concomitant disease that leads to survival<3 years

• Willing and able to comply with study protocol Written agreement consent beforeenrolment and full aware of the right to quit the study at any time with no loss

Exclusion Criteria:

• Uncontrolled seizure, central nervous system diseases, or mental disorders;

• Past history of upper abdominal surgery (except for laparoscopic cholecystectomy)

• Past history of gastric surgery (including diagnosis procedure such as ESD and EMR)

• Other malignant diseases in 5 years (except for cured skin carcinoma and cervicalcarcinoma in situ)

• Clinical severe or active heart diseases, such as symptomatic coronary heart disease,NYHA grade II or above congestive heart failure, severe arrhythmia, or myocardialinfarction in 6 months

• Cerebral hemorrhage or infarction in 6 months

• Organ transplant recipients under immunosuppressive therapy

• Severe uncontrolled repeated infection or other severe uncontrolled concomitantdiseases

• Medium or severe renal damage (creatinine clearance rate≤50ml/min or serum creatinine>upper limit of normal value)

• Other diseases requiring synchronous surgery

• Requiring emergent surgery due to oncologic emergent (e.g. bleeding, perforation,obstruction)

• FEV1<50% of expected value Participated in other studies 4 weeks before therandomization.