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.

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.

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.

Purpose: Nodal downstaging after preoperative therapy for gastric cancer has been shown to impart excellent prognosis, but this has not been validated in a national cohort. The role of neoadjuvant chemoradiation (NACR) in nodal downstaging remains unclear when compared with that of neoadjuvant chemotherapy alone (NAC). Furthermore, it is unknown whether the prognostic implications of nodal downstaging differ by preoperative regimen. Materials and Methods: Using the National Cancer Database, overall survival (OS) duration was compared among natural N0 (cN0/ypN0), downstaged N0 (cN+/ypN0), and nodepositive (ypN+) gastric cancer patients treated with NACR or NAC. Factors associated with nodal downstaging were examined in a propensity score-matched cohort of cN+ patients, matched 1:1 by receipt of NACR or NAC. Results: Of 7,426 patients (natural N0 [n=1,858, 25.4%], downstaged N0 [n=1,813, 24.4%], node-positive [n=3,755, 50.4%]), 58.2% received NACR, and 41.9% received NAC. The median OS durations of downstaged N0 (5.1 years) and natural N0 (5.6 years) patients were similar to one another and longer than that of node-positive patients (2.1 years) (P<0.001). In the matched cohort of cN+ patients, more recent diagnosis (2010–2015 vs. 2004–2009) (odds ratio [OR], 2.57; P<0.001) and NACR (OR, 2.02; P<0.001) were independently associated with nodal downstaging. The 5-year OS rate of downstaged N0 patients was significantly lower after NACR (46.4%) than after NAC (57.7%) (P=0.003). Conclusions Downstaged N0 patients have the same prognosis as natural N0 patients.Nodal downstaging occurred more frequently after NACR; however, the survival benefit of nodal downstaging after NACR may be less than that when such is achieved by NAC.