微创手术在局部晚期胃癌（LAGC）治疗中提供了多种临床优势，尽管其应用标准尚不清楚。对于经常出现虚弱、合并症和其他致残疾病的老年患者来说，手术仍然是一个谨慎的选择。本研究旨在评估腹腔镜胃切除术对患有 LAGC 的老年患者的可能优势。这项回顾性研究分析了 2015 年至 2020 年间接受 LAGC 根治性切除术的单中心老年患者系列（≥75 岁）。对开腹手术与腹腔镜手术进行了比较分析，重点关注术后并发症、住院时间 (LOS) ，并能长期生存。共有 62 名患者通过开放或腹腔镜手术接受了胃切除术（各 31 例）。研究人群在人口统计学、手术风险和新辅助化疗方面没有显示出统计学上的显着差异。腹腔镜组报告总体并发症显着减少（45.2% vs. 71%，p = 0.039）和肺部并发症（0 vs. 9.7%，p = 0.038），并且 LOS 更短（8 天 vs. 12 天，p = 0.007） 。尽管腹腔镜胃切除术后长期总生存率显着提高（p = 0.048），但在无病生存率和疾病特异性生存率方面没有相关差异，但各组之间的淋巴结收获相同。腹腔镜胃切除术对老年 LAGC 患者有效，可提供显着的短期和长期术后益处。

Minimally invasive surgery has provided several clinical advantages in locally advanced gastric cancer (LAGC) care, although a consensus on its application criteria remains unclear. Surgery remains a careful choice in elderly patients, who frequently present with frailty, comorbidities, and other disabling diseases. This study aims to assess the possible advantages of laparoscopic gastric resections in elderly patients presenting with LAGC. This retrospective study analyzed a single-center series of elderly patients (≥75 years) undergoing curative resections for LAGC between 2015 and 2020. A comparative analysis of open versus laparoscopic approaches was conducted, focusing on postoperative complications, length of hospital stay (LOS), and long-term survival. A total of 62 patients underwent gastrectomy through an open or a laparoscopic approach (31 pts each). The study population did not show statistically significant differences in demographics, operative risk, and neoadjuvant chemotherapy. The laparoscopic group reported significantly minimized overall complications (45.2 vs. 71%, p = 0.039) and pulmonary complications (0 vs. 9.7%, p = 0.038) as well as a shorter LOS (8 vs. 12 days, p = 0.007). Lymph node harvest was equal between the groups, although long-term overall survival presented significantly better after laparoscopic gastrectomy (p = 0.048), without a relevant difference in terms of disease-free and disease-specific survivals. Laparoscopic gastrectomy proves effective in elderly LAGC patients, offering substantial short- and long-term postoperative benefits.