Surgery for gastric cancer patients of age 85 and older: Multicenter survey

Abstract

AIMTo investigate the surgical therapies for gastric cancer (GC) patients of age 85 or older in a multicenter survey.METHODSTherapeutic opportunities for elderly GC patients have expanded in conjunction with extended life expectancy. However, the number of cases encountered in a single institution is usually very small and surgical therapies for elderly GC patients have not yet been standardized completely. In the present study, a total of 134 GC patients of age 85 or older who underwent surgery in 9 related facilities were retrospectively investigated. The relationships between surgical therapies and clinicopathological or prognostic features were analyzed.RESULTSEighty-nine of the patients (66%) presented with a comorbidity, and 26 (19% overall) presented with more than two comorbidities. Radical lymphadenectomy was performed in 59 patients (44%), and no patient received pre- or post-operative chemotherapy. Forty of the patients (30%) experienced perioperative complications, but no surgical or perioperative mortality occurred. Laparoscopic surgery was performed in only 12 of the patients (9.0%). Univariate and multivariate analyses of the 113 patients who underwent R0 or R1 resection identified the factors of pT3/4 and limited lymphadenectomy as predictive of worse prognosis (HR = 4.68, P = 0.02 and HR =2.19, P = 0.05, respectively). Non-cancer-specific death was more common in cStage I patients than in cStage II or III patients. Limited lymphadenectomy correlated with worse cancer-specific survival (P = 0.01), particularly in cStage II patients (P < 0.01). There were no relationships between limited lymphadenectomy and any comorbidities, except for cerebrovascular disease (P = 0.07).CONCLUSIONNon-cancer-specific death was not negligible, particularly in cStage I, and gastrectomy with radical lymphadenectomy appears to be an effective treatment for cStage II elderly GC patients.

Safety and feasibility of laparoscopic gastrectomy accompanied by D1+ lymph node dissection for early gastric cancer in elderly patients

“…Elderly patients usually have various comorbidities and therefore a shorter life expectancy than younger patients . In the present study, comorbidities such as hypertension and neurological diseases were more frequent in elderly patients than younger patients, and the ASA score tended to reflect the baseline diseases and comorbidities in each group.…”

“…Additionally, the Advanced Elderly Medical Service System in Japan, which provides benefits to reduce individual payments of medical expenses, also uses this cut‐off for applicants to qualify. The age of patients with gastric cancer has increased , and elderly patients often have comorbidities, such as circulatory and respiratory diseases, and a limited ability to engage in activities of daily living . Cancer therapies are crucial for elderly patients , but few large‐scale studies have evaluated the safety and feasibility of LG in elderly patients .…”

Role of Laparoscopic Gastrectomy in Very Elderly Patients with Gastric Cancer Who Have Outlived the Average Lifespan

“…Randomized clinical trials, as well as many retrospective studies, have revealed advantages of laparoscopic gastrectomy over open gastrectomy in terms of early recovery, less pain, and fewer complications [ 5 10 11 ]. There have been several attempts to explore the feasibility of gastrectomy in elderly patients because of changes in the average lifespan globally [ 12 13 14 ]. Similar results for elderly patients, such as less blood loss and early recovery of the patients ≥80 years of age, have been reported.…”

“…The objective was to explore whether surgical treatment for specific elderly patients would be beneficial for their remaining lifespan. One study reported that non-cancer-specific deaths in elderly patients with clinical stage I gastric cancer could be negligible with laparoscopic gastrectomy [ 12 ]. In our study, 5 patients with stage I gastric cancer died of non-cancer-related reasons within a year of surgery.…”

Retrospective Analysis of the Outcomes in Elderly Patients with Adenocarcinoma of the Stomach and Esophagogastric Junction Following Three Different Treatments

“…3 Cancer-specific survival was 100% in clinical stage I. which can imply that this group died from non-cancer diseases. 4 Surgery with reduced nodal dissection in stage I disease also offered no significant difference in survival compared to standard surgery. 5 Furthermore, complications in patients who underwent curative surgery were more common in older age, especially medical complications, occurring in 7.4% of patients aged 80 years old or older compared to 2.2% of patients aged 60-64 years old 6 , particularly cardiac events and pulmonary complications, such as pneumonia and respiratory failure.…”