Gastrectomy in Octogenarians With Gastric Cancer: Is It Feasible?

Abstract

Background: The octogenarian population is expanding worldwide and demand for gastrectomy due to gastric cancer in this population is expected to grow. However, the outcomes of surgery with curative intent in this age group are poorly reported and it is unclear what matters most to survival: age, clinical status, disease´s stage, or the extent of the surgery performed. Aim: Evaluate the results of gastrectomy in octogenarians with gastric cancer and to verify the factors related to survival. Methods: From prospective database, patients aged 80 years or older with histologically confirmed adenocarcinoma who had undergone gastrectomy with curative intent were selected. Factors related to postoperative complications and survival were studied. Results: Fifty-one patients fulfilled the inclusion criteria. A total of 70.5% received subtotal gastrectomy and in 72.5% D1 lymphadenectomy was performed. Twenty-five (49%) had complications, in eleven major complications occurred (seven of these were clinical complications). Hospital length of stay was longer (8.5 vs. 17.8 days, p=0.002), and overall survival shorter (median of 1.4 vs. 20.5 months, p=0.009) for those with complications. D2 lymphadenectomy and the presence of postoperative complications were independent factors for worse overall survival. Conclusion: Octogenarians undergoing gastrectomy with curative intent have high risk for postoperative clinical complications. D1 lymphadenectomy should be the standard of care in these patients.

Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy

“…Similarly, in our cohort, we also observed that the incidence of major POC was higher in the high-ALBI group, including the mortality at 30 d and 90 d. One of the justifications for this result is probably related to the age of patients, since high-ALBI group are generally older, as seen in our study. So, it may represent a frail group of patients with a higher risk of complications[ 28 ]. Still, poor nutritional status can contribute to a higher risk of POC[ 29 ], since preoperative hypoproteinemia has already been reported as a risk factor for postoperative infection in gastrointestinal surgery[ 30 ].…”

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

“…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.…”

Does Age Influence in Endoscopic Therapeutic Success on the Biliary Tract?

“…In parallel to the increase in life expectancy both nationally and worldwide 11 and the increase in the incidence of biliopancreatic diseases in this population, the performance of ERCP in the elderly has become increasingly frequent because they bring comorbidities inherent to age, such as systemic arterial hypertension, diabetes mellitus, coronary artery disease 13 . Consequently, the performance of ERCP, which is recognized for having lower morbidity and mortality compared to surgical treatment, has been increasingly indicated as a treatment for these biliary and pancreatic diseases.…”