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

Abstract

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.

Geriatric Nutrition Index Influences Survival Outcomes in Gastric Carcinoma Patients Undergoing Radical Surgery

“…It is noteworthy that patients with a low GNRI who also received total gastrectomy showed very poor 5‐year OS in our study. Given the high non–GC‐related death rate in this population, 45 our results may underscore the possibility of GNRI facilitating the identification of severely malnourished patients medically unfit to undergo total gastrectomy. Treatment strategies should be tailored according to not only cancer status but also physiological status, especially in frail patients.…”

“…Total gastrectomy is a highly invasive procedure with considerable morbidity, 41,42 leading to marked nutrition deterioration postoperatively, 43,44 resulting in poor long-term outcomes. 41,42 Given that total gastrectomy affects survival outcomes especially in frail patients such as the elderly, 45,46 identification of patients who are vulnerable to the invasive approach is crucial for optimizing therapeutic strategies. It is noteworthy that patients with a low GNRI who also received total gastrectomy showed very poor 5-year OS in our study.…”

Near-focus magnification and second-generation narrow-band imaging for early gastric cancer in a randomized trial

“…The exclusion criteria were: (1) a history of gastrectomy, (2) a history of gastric tube reconstruction, (3) presence of serious underlying disease, (4) subjects taking routine antithrombogenic agents which might preclude obtaining biopsy specimens, (5) subjects who have undergone emergency endoscopy, (6) subjects who participated in this study within the last 8 months. A recent nation-wide study reported that the proportion of elderly patients aged 75 years or older accounted for 47% of Stage I GC patients who underwent gastrectomy [18]. Therefore, we recruited patients aged up to 85 years old.…”

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

“…63 As a disadvantage of additional gastrectomy, postoperative complications, mortality, and deteriorated quality of life (QOL) were reported. 62,[64][65][66][67][68] According to the nationwide registry data of Japan, postoperative 90-day mortality rate was 0.3% in patients aged ≤74 years; In contrast, it was 1.2-5.1% in patients aged ≥75 years. Regarding ER, some reports showed its favorable outcome and safety in elderly patients.…”