Impact of Aging in the Surgical Outcomes of Gastric Cancer Patients

Abstract

BACKGROUND: As age advances, a higher burden of comorbidities and less functional reserve are expected, however, the impact of aging in the surgical outcomes of gastric cancer (GC) patients is unknown. OBJECTIVE: The aim of this study is to evaluate surgical outcomes of GC patients according to their age group. METHODS: Patients submitted to gastrectomy with curative intent due to gastric adenocarcinoma were divided in quartiles. Each group had 150 patients and age limits were: ≤54.8, 54.9-63.7, 63.8-72, >72. The outcomes assessed were: postoperative complications (POC), 90-day postoperative mortality, disease-free survival (DFS) and overall survival (OS). RESULTS: Major surgical complications were 2.7% in the younger quartile vs 12% for the others (P=0.007). Major clinical complications raised according to the age quartile: 0.7% vs 4.7% vs 5.3% vs 7.3% (P<0.042). ASA score and age were independent risk factors for major POC. The 90-day mortality progressively increased according to the age quartile: 1.3% vs 6.0% vs 7.3% vs 14% (P<0.001). DFS was equivalent among quartile groups, while OS was significantly worse for those >72-year-old. D2 lymphadenectomy only improved OS in the three younger quartiles. Age >72 was an independent risk factor for worse OS (hazard ratio of 1.72). CONCLUSION: Patients <55-year-old have less surgical complications. As age progresses, clinical complications and 90-day mortality gradually rise. OS is worse for those above age 72, and D2 lymphadenectomy should be individualized after this age.

Gastrectomy for elderly gastric cancer patients: A propensity score‐matching analysis

“…[18][19][20] Recently, it was demonstrated that those under age 55 years have fewer POC and, as age increases, clinical complications and mortality in 90-day rise. 4,21 OS after 72 years old is worse and octogenarians have increased risk for postoperative clinical complications. Also, age ≥ 75 years was an independent risk factor for shorter DFS.…”

“…Three large series have demonstrated that OA correlated with worse prognosis; however crucial data, such as radicality, were missing in these studies 18–20 . Recently, it was demonstrated that those under age 55 years have fewer POC and, as age increases, clinical complications and mortality in 90‐day rise 4,21 . OS after 72 years old is worse and octogenarians have increased risk for postoperative clinical complications 3,4 .…”

“…Recently, it was demonstrated that those under age 55 years have fewer POC and, as age increases, clinical complications and mortality in 90‐day rise 4,21 . OS after 72 years old is worse and octogenarians have increased risk for postoperative clinical complications 3,4 . However, several confounding factors may influence results: comorbidities increase with age, whereas the functional status decreases; young patients have more aggressive histological characteristics; only elders considered fit enough undergo surgery; and lymphadenectomy is usually restricted in elders.…”

“…Although its incidence has decreased, the elderly population with GC has increased in recent years. As surgery is the most effective treatment for resectable GC and life expectancy is rising, the need for surgery in the elderly population is also expected to increase 2–4 …”

“…is the most effective treatment for resectable GC and life expectancy is rising, the need for surgery in the elderly population is also expected to increase. [2][3][4] In GC patients, older age (OA) has been associated with increased postoperative complications (POC), longer hospital stay, hospital mortality, and worse oncological outcomes. [5][6][7][8] However, some reported that age itself is not an independent predictor for survival, and that the prognosis of older and younger patients is similar.…”