Predictors of postoperative complications in elderly and oldest old patients with gastric cancer

Abstract

Background The incidence of gastric cancer has been increasing among elderly persons in Japan. This study aimed to clarify risk factors for postoperative complications in oldest old patients with gastric cancer. Methods One-hundred ninety patients more than 75 years old with gastric cancer underwent gastrectomy between 2000 and 2011. Patients were classified into two groups: group A included 29 patients who were 85 years or older (oldest old patients), and group B included 161 patients who were 75-84 years of age. Perioperative parameters associated with complications were compared in each group. Results The preoperative estimated glomerular filtration rate was significantly lower in group A (p = 0.03). The two groups significantly differed in performance status (p = 0.018). Patients in group A received a lesser extent of lymph node dissection and had fewer lymph nodes excised. As a result, the duration of the operation was significantly shorter in group A. There were no significant differences in the frequency or grade of total complications or mortality between the two groups. Operative hemorrhage ([300 ml) and Hiroshima POSSUM (predicted morbidity risk [40) were risk factors in both groups A and B; the risk factors of preoperative serum albumin level and prognostic nutritional index (PNI) were specific to group A.Conclusions Adjustments to the extent of surgery among oldest old patients most likely reduces the incidence of postoperative complications in this group. Preoperative serum albumin level and PNI are significant predictors of postoperative complications in oldest old patients with gastric cancer.

Morbidity and mortality according to age following gastrectomy for gastric cancer

“…These studies also suggested that age alone is not the main factor predicting postoperative outcome. However, previous studies of age‐related differences in gastric cancer surgery were mainly small cohort studies and failed to identify adequate alternative predictors.…”

Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric adenocarcinoma

“…Mortality rates for elderly patients undergoing resection for gastric cancer vary considerably in the literature, ranging from 2% to 10.1% in Asian studies and 3% to 8% in European studies 17‐30 . This inconsistency is corroborated by US studies showing 30 days postoperative mortality rates specifically in octogenarians of 5%, 10.2%, and 7.2% using single‐institutional, multi‐institutional, and ACS‐NSQIP data respectively 31‐33 .…”

“…This inconsistency is corroborated by US studies showing 30 days postoperative mortality rates specifically in octogenarians of 5%, 10.2%, and 7.2% using single‐institutional, multi‐institutional, and ACS‐NSQIP data respectively 31‐33 . In contrast, these studies have established mortality rates ranging from 0% to 4.1% in their younger patients, with conflicting data on whether or not survival differs between elderly and younger patients 17‐24,26,27‐30,32,33 . Data are similarly conflicting with regards to the outcomes of elderly vs young patients with GE junction tumors undergoing esophagectomy 34‐36 .…”

“…Mortality rates for elderly patients undergoing resection for gastric cancer vary considerably in the literature, ranging from 2% to 10.1% in Asian studies and 3% to 8% in European studies. [17][18][19][20][21][22][23][24][25][26][27][28][29][30] This inconsistency is corroborated by US studies showing 30 days postoperative mortality rates specifically in octogenarians of 5%, 10.2%, and 7.2% using single-institutional, multi-institutional, and ACS-NSQIP data respectively. [31][32][33] In contrast, these studies have established mortality rates ranging from 0% to 4.1% in their younger patients, with conflicting data on whether or not survival differs between elderly and younger patients.…”

“…[31][32][33] In contrast, these studies have established mortality rates ranging from 0% to 4.1% in their younger patients, with conflicting data on whether or not survival differs between elderly and younger patients. [17][18][19][20][21][22][23][24]26,[27][28][29][30]32,33 Data are similarly conflicting with regards to the outcomes of elderly vs young patients with GE junction tumors undergoing esophagectomy. [34][35][36] This study aims to compare perioperative outcomes and survival of patients age 80 or older with younger patients undergoing curative resection for esophagogastric adenocarcinoma at our institution.…”