Impact of Gastric Cancer Surgery in Elderly Patients

Wakahara, Tomoyuki; Ueno, Naohiko; Maeda, Takeyasu; Kanemitsu, Kiyonori; Yoshikawa, Tomoyuki; Tsuchida, Shinobu; Toyokawa, Akihiro

doi:10.1159/000481404

Cited by 30 publications

(21 citation statements)

References 14 publications

(14 reference statements)

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“…The overall complication rate after gastrectomy in GC patients over 80 years of age was reported to be 30.8% in a recent study (18). The present study demonstrated that complications with a Clavien-Dindo classification≥grade II were observed in 24.8% of patients, which is consistent with the results of previous reports on elderly GC patients (19,20). In previous studies analyzing elderly GC patients, the elderly group tended to have lower ASA-PS, hemoglobin levels, and serum albumin levels than the control group.…”

Section: Discussionsupporting

confidence: 92%

Risk Factors for Overall Complications and Remote Infection After Gastrectomy in Elderly Gastric Cancer Patients

Nakamura

Kaida

Tomita

et al. 2021

In Vivo

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Background/Aim: A significant predictive factor for the occurrence of complications after gastrectomy in elderly gastric cancer patients is yet to be determined. We aimed to evaluate the clinical factors associated with overall complications including remote infection after gastrectomy in elderly gastric cancer patients. Patients and Methods: We retrospectively analyzed data of 101 patients aged over 80 years, who underwent curative gastrectomy. We analyzed the clinicopathological factors that were independently associated with the occurrence of overall complications or remote infection by a logistic regression model. Results: The overall complication rate was 24.8%. We identified pneumonia as a remote infection, and the occurrence rate of remote infections was 5.9%. On multivariate analysis, hemoglobin (<11 g/dl) and operation time (>240 min) were significantly correlated with the occurrence of overall complications. Regarding the occurrence of remote infection, performing total gastrectomy and a hemoglobin level <11 g/dl were identified as significant risk factors. Conclusion: Preoperative anemia and intraoperative factors, including the surgical procedure, could affect the occurrence of postoperative complications in elderly patients.

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Section: Discussionsupporting

confidence: 92%

Risk Factors for Overall Complications and Remote Infection After Gastrectomy in Elderly Gastric Cancer Patients

Nakamura

Kaida

Tomita

et al. 2021

In Vivo

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“…However, this database included all stages of gastric cancer surgical cases and revealed only short-term outcomes without survival data after surgery for gastric cancer. In other reports for elderly gastric cancer patients, the patient selection was biased, and the number of patients was limited [7][8][9]. The present data were specific for elderly patients with Stage I gastric cancer, which allowed us to analyze various factors associated with short-and long-term outcomes for various age groups.…”

Section: Discussionmentioning

confidence: 98%

Surgical outcomes of elderly patients with Stage I gastric cancer from the nationwide registry of the Japanese Gastric Cancer Association

et al. 2019

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Background The proportion of elderly patients undergoing surgery for gastric cancer is increasing. However, limited number of therapeutic outcomes in the elderly has been reported. Here we examined the surgical results based on a nationwide survey of elderly patients who underwent surgery for Stage I gastric cancer. Methods Data from 68,353 Stage I patients who underwent gastrectomy between 2001 and 2007 were retrospectively collected. The accumulated data were reviewed and analyzed by the Japanese Gastric Cancer Association registration committee. We first classified the patients as those aged ≤ 74 years and ≥ 75 years. We further classified those patients aged ≥ 75 years into groups by 5-year increments to examine their short-and long-term postoperative outcomes. Results Patients aged ≥ 75 years accounted for 46.5%. The 30-day mortality rate was < 0.7% for any age group, but for those aged ≥ 75 years, the 60-day and 90-day mortality rates were 0.9-2.3% and 1.2-5.1%, respectively. An examination of long-term survival indicated that, as the class of age increased, the 5-year overall survival (OS) was 47.0-93.1% and diseasespecific survival (DSS) was 91.4-98.2%, respectively. Although high DSS rates of ≥ 90% were found for all age groups, OS only accounted for ≤ 82% of patients aged ≥ 75 years. Conclusion Among elderly patients with Stage I gastric cancer, deaths due to other diseases were frequently observed in the long term. Thus, for elderly patients, it may be appropriate to reconsider the treatment strategy with respect to the balance between the invasiveness of the treatment and the prognosis.

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“…Thus, it is important that a preoperative evaluation be performed to see if a patient can tolerate the stress caused by surgery. Several authors reported acceptable postoperative morbidity rates after gastric cancer surgery in elderly patients, although they were higher than those of younger patients [15,16], while others reported that postoperative morbidity rates were similar between elderly and nonelderly patients [17]. Regarding long-term outcomes after gastric cancer surgery, we previously reported that the outcomes of elderly patients were relatively worse than those of younger patients; however, the difference was not statistically significant [16].…”

Section: Discussionmentioning

confidence: 79%

“…Several authors reported acceptable postoperative morbidity rates after gastric cancer surgery in elderly patients, although they were higher than those of younger patients [15,16], while others reported that postoperative morbidity rates were similar between elderly and nonelderly patients [17]. Regarding long-term outcomes after gastric cancer surgery, we previously reported that the outcomes of elderly patients were relatively worse than those of younger patients; however, the difference was not statistically significant [16]. It has also been reported that the overall survival rate of elderly patients with gastric cancer treated with surgery is significantly higher than that of those given only the best supportive care, especially in cases of advanced cancer [18].…”

Section: Discussionmentioning

confidence: 99%

Validity of Laparoscopic Gastrectomy in the Elderly

et al. 2018

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Objectives: This study aimed to investigate the validity of laparoscopic gastric cancer surgery in elderly patients. Methods: A total of 202 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2007 and December 2016 were divided into an elderly group (age ≥75 years, n = 36) and a control group (age < 75 years, n = 166). The patients’ clinicopathological data were reviewed. Results: The overall morbidity rate was relatively higher in the elderly group (16.7 vs. 11.4%, p = 0.389), whereas the incidence of serious complications ≥grade III according to the Clavien-Dindo classification did not increase significantly in the elderly group (8.3 vs. 7.8%, p = 0.920). Univariate and multivariate analyses revealed that age ≥75 years was not a significant predictive factor of postoperative morbidity (p = 0.568). There was no significant difference in the 5-year overall survival rate of patients with pathological stage I gastric cancer between the groups (97.1 vs. 96.1%, p = 0.704; hazard ratio, 0.669; 95% confidence interval, 0.036–3.692). Conclusions: Laparoscopic gastrectomy has an acceptable morbidity rate in elderly patients, and the long-term outcome of patients with stage I gastric cancer was similar to that of the control group.

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Impact of Gastric Cancer Surgery in Elderly Patients

Cited by 30 publications

References 14 publications

Risk Factors for Overall Complications and Remote Infection After Gastrectomy in Elderly Gastric Cancer Patients

Risk Factors for Overall Complications and Remote Infection After Gastrectomy in Elderly Gastric Cancer Patients

Surgical outcomes of elderly patients with Stage I gastric cancer from the nationwide registry of the Japanese Gastric Cancer Association

Validity of Laparoscopic Gastrectomy in the Elderly

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