Surgical Outcomes of Gastrectomy for Elderly Patients with Gastric Cancer

Takeshita, Hitoshi; Ichikawa, Daisuke; Komatsu, Shuhei; Kubota, Takeshi; Okamoto, Kazuma; Shiozaki, Atsushi; Fujiwara, Hitoshi; Otsuji, Eigo

doi:10.1007/s00268-013-2210-7

Cited by 110 publications

(94 citation statements)

References 32 publications

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“…There are several possible explanations for comparable surgical outcomes in the oldest old patients. Takeshita et al [39] reported that surgical outcomes in elderly patients were comparable to those in nonelderly patients. They suggested that the biological behavior of the tumor (e.g., tumor growth and metastatic potential) may differ between elderly and young patients.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2014

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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.

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Section: Discussionmentioning

confidence: 98%

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

et al. 2014

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“…Several authors also reported that greater blood loss during surgery is associated with an increased postoperative morbidity rate [10,11]. The amount of blood lost during surgery is directly correlated with the type of gastrectomy, extent of lymph node dissection, or combined resection of other organs; however, an inappropriate surgical maneuver such as dissection of an incorrect layer or injury to adjacent organs is also an important factor.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies [11,15] from Japan also showed that overall survival after gastric cancer surgery was worse among elderly patients aged ≥80 years than among younger patients. However, these studies included patients who had undergone surgery more than 20 years ago.…”

Section: Discussionmentioning

confidence: 99%

Impact of Gastric Cancer Surgery in Elderly Patients

Wakahara

Ueno²,

Maeda³

et al. 2017

Oncology

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Objectives: This study aimed to investigate the validity of gastric cancer surgery in elderly patients. Methods: A total of 544 patients who underwent elective gastrectomy for gastric cancer were divided into an elderly group (age ≥75 years, n = 171) and a control group (age <75 years, n = 373). The clinicopathological data of the patients were reviewed. Results: The overall morbidity rate (26.3 vs. 16.1%, p = 0.005) and the incidence rate of anastomotic leakage (6.4 vs. 1.6%, p = 0.003) were significantly higher in the elderly group. The proportion of patients who had severe complications (≥grade IIIa) was relatively higher in the elderly group (10.5 vs. 5.7%); however, the difference was not significant (p = 0.074). A stage-matched survival analysis revealed no significant differences between the groups (stage I: p = 0.978; stage II: p = 0.964; stage III: p = 0.199). For the pathological stages II and III, the overall survival of the patients in the elderly group who received adjuvant chemotherapy for >3 months was significantly better than that of the patients who received it for ≤3 months or did not receive it (p = 0.023). Conclusions: An aggressive treatment strategy should be adopted in selected elderly patients with gastric cancer.

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“…The functional capacity of organs decreases with age, resulting in a decreased reserve and lower ability to endure stress (17); therefore, advanced age is a significant risk factor for increased mortality (18). However, advances in surgical and anesthesiology techniques have reportedly reduced surgical complications and have, consequently, improved the short-term surgical outcomes in elderly patients (19,20).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients

Kasahara

Tsujimoto

Hiraki

et al. 2016

Molecular and Clinical Oncology

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Abstract. Elderly patients are often considered as high-risk for major abdominal surgery due to reduced functional reserve and increased comorbidities. We herein evaluated the efficacy of totally laparoscopic distal gastrectomy (TLDG) in elderly patients with gastric cancer by measuring the postoperative systemic responses and postoperative analgesic consumption. A total of 102 patients with gastric cancer [57 who underwent TLDG and 45 who underwent laparoscopy-assisted distal gastrectomy (LADG)] were enrolled in this study. The patients were classified as elderly (aged ≥75 years) and non-elderly (aged <75 years) groups. The surgical outcome and postoperative analgesic consumption were evaluated. The elderly group exhibited a higher incidence of comorbidities and a longer postoperative hospital stay compared with those of younger patients, although there was no difference in the incidence of postoperative complications. In addition, the total consumption of additional analgesics until postoperative day 5 in patients who underwent TLDG was significantly lower compared with that in patients who underwent LADG in the elderly group; there was no such difference in the non-elderly group. The results suggested that TLDG was better for the management of postoperative pain in elderly patients with gastric cancer, who exhibit the highest mortality rates in the adult surgical population.

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Surgical Outcomes of Gastrectomy for Elderly Patients with Gastric Cancer

Abstract: The treatment results in elderly patients were comparable to those in nonelderly patients. These findings suggest that R0 resection with at least limited lymph node dissection according to Japanese guidelines should be considered, even for elderly patients.

Cited by 110 publications

References 32 publications

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

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

Impact of Gastric Cancer Surgery in Elderly Patients

Efficacy of totally laparoscopic distal gastrectomy for gastric cancer in elderly patients

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