Reduced-Port Laparoscopic Distal Gastrectomy in Patients Aged ≥ 75 Years Versus <75 Years: Comparable Surgical Outcomes and Higher Medical Complication Events

Background and Objectives: This study aimed to evaluate the safety and feasibility of reduced-port laparoscopic distal gastrectomy (RPLDG) in elderly patients. Materials and Methods: Electronic medical records of 226 patients who underwent RPLDG performed by a single high-volume surgeon at a single institution (Chonnam National University Hospital) between January 2015 and April 2020 were retrospectively analyzed. Among these patients, 60 were aged ≥ 75 years (elderly group), and 166 were younger than 75 years (non-elderly group). Patient characteristics, surgical outcomes, and short-term postoperative outcomes were compared between the two groups. Results: Surgical outcomes were comparable between the age groups. However, medical complication events, assessed using an event-based approach allowing multiple events per patient, were more frequent in patients aged ≥ 75 years. Compared with the non-elderly group, the elderly group demonstrated a higher frequency of overall postoperative complication events (18 [30%] vs. 29 [18%], p = 0.040), primarily attributable to medical complications (9 [15%] vs. 6 [4%], p < 0.01). The elderly group also showed a delayed time to first gas passage (3.5 [3.0–4.0] vs. 3.0 [3.0–3.0] days, p < 0.001). However, no statistically significant differences were observed in length of hospital stay (7.0 [6.0–10.0] vs. 6.0 [6.0–8.0] days, p = 0.262) or intraoperative blood loss (p = 0.831). No significant differences were found in surgical complication events (p = 0.05) or Clavien–Dindo grade ≥ 3 complication events (p = 0.13). In the risk factor analysis for complications, univariate analysis identified age ≥ 75 years as a significant factor. However, in the multivariate analysis, only respiratory comorbidities, liver disease, and poor ECOG performance status remained independent risk factors, whereas age ≥ 75 years was no longer statistically significant (p = 0.193). The finding regarding liver disease should be interpreted with caution because of the extremely small sample size. Conclusions: RPLDG appears to be a viable surgical option for patients aged ≥ 75 years, demonstrating acceptable surgical outcomes and severe complication rates comparable to those observed in non-elderly patients.