Surgical Mortality, Survival, and Quality of Life after Resection for Gastric Cancer in the Elderly

Abstract

Although there were some studies on clinicopathologic characteristics, operative morbidity, and mortality in elderly patients with gastric cancer, no reports have specifically focused on survival and quality of life after resection. A total of 433 patients aged >/= 65 years (1987-1994) who underwent gastric resection for gastric adenocarcinoma were studied. Two groups were considered: patients aged 65 to 74 years and those > 74 years. Most of the patients (78.1%) had advanced diseases, and nearly half (41. 3%) had associated chronic disease(s). Resections with curative intention were performed in 362 patients (83.6%). The overall operative morbidity rate was 21.7% and mortality rate 5.1%. Although operative procedures were similar in both groups, patients aged >74 years had a higher mortality rate than those aged 65 to 74 years (10. 1% vs. 3.5%; p = 0.034). Age and extent of gastric resection were two independent factors negatively affecting mortality. The cumulative survival rates for patients who underwent curative resection were 86.2%, 72.4%, 67.2%, 62.9%, and 60.0% at 1, 2, 3, 4, and 5 years, respectively. Nearly all patients (96%) after surgery had normal work and daily activities. Some patients appeared to lack energy (16%) or experienced a period of anxiety or depression. There was no statistical difference in survival and quality of life assessed by the Spitzer index after curative resection between the two groups. Therefore resection with curative intention can be performed for the elderly with acceptable morbidity and mortality rates, possible long-term survival, and good quality of life, but a limited operation should be considered in the very elderly patients.

Pathologic characteristics of gastric cancer in the elderly: a retrospective study of 994 surgical patients

“…Several reports have indicated that differentiatedtype or intestinal-type carcinomas are more common in older patients than in younger patients [3,[5][6][7][8][14][15][16]18,19]. Our study demonstrated that this tendency was clear, especially in early-stage cancer.…”

“…Previous reports have shown no significant difference in the incidence of lymph node metastasis between young and elderly patients with gastric cancer [3,[5][6][7][14][15][16][17][18][19]. Most of these reports did not take the clinical or pathological stage of the disease into account, and the results could not be simply compared with each other.…”

“…On the other hand, there was no clear trend of risk patterns involving carcinoma of the upper third of the stomach. Some investigators have reported that gastric cancer involving the upper third of the stomach in the elderly was more common than in younger groups [6,7,[15][16][17]19], whereas others found no significant difference or lower prevalence in the elderly group [3,8,14,18].…”

“…Previous reports demonstrated that the proportion (range, 42%-63%) of carcinomas in the lower third of the stomach in the elderly was higher than the proportion (range, 31%-44%) in the young [3,[6][7][8][9][14][15][16][17][18][19]. Our data confirmed that, in patients aged 85 years or older, cancers were situated more often in the lower third of the stomach compared with the younger age groups.…”

Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases

“…In literature, controversy remains about the influence of chronologic age on the nodal status in gastric carcinoma. Most previous reports have negated a significant difference in the rates of LN metastasis between younger and elderly patients [37][38][39][40], whereas in cases of early gastric cancer several authors have reported a higher prevalence of LN involvement for elderly patients [41,42].…”