Factors Related to Morbidity in Elderly Gastric Cancer Patients Undergoing Gastrectomies

Abstract

PurposeThe prevalence of gastric cancer in the elderly is increasing. The purpose of this study was to clarify factors related to morbidity following gastric cancer surgery in elderly patients.Materials and MethodsFor this study, data from 411 patients who underwent curative gastrectomies with lymph node dissections between March 2010 and January 2013 were retrospectively studied using a prospectively designed database. Patients were divided into 2 groups (<70 years vs. ≥70 years). For each group, perioperative factors were analyzed to determine if they were associated with postoperative morbidity and mortality.ResultsComorbidities were more prevalent in the elderly group (≥70 years). Intraoperative and postoperative transfusions were also more frequently required in the elderly group. There was no significant difference in the number of retrieved lymph nodes between the 2 groups (44.3 vs. 46.6 nodes). In a comparison of the elderly versus non-elderly groups, the postoperative morbidity rates were 22.7% versus 8.9% (P<0.001) and the postoperative mortality rates were 4.2% versus 0% (P=0.002), respectively. Of the possible non-surgical complications, pulmonary problems were predominately found in the elderly group (P<0.001). Surgical complications were evenly distributed between the 2 groups (P=0.463). Postoperative morbidity was significantly associated with older age and postoperative transfusion. Multivariate analysis showed that higher body mass index (BMI) and postoperative transfusion were important factors associated with postoperative complications in the elderly group.ConclusionsPulmonary complications were frequently problematic in elderly patients. Higher BMI and postoperative transfusion were significant risk factors for postoperative complications in elderly patients with gastric cancer.

Morbidity and mortality according to age following gastrectomy for gastric cancer

“…However, most studies failed to address a good alternative for preoperative risk assessment by multivariable analysis of patient, tumour and treatment characteristics. In line with the present results, Shin and colleagues reported that older age (at least 70 years) and BMI were independent risk factors for the occurrence of complications. Here, BMI below 18·5 kg/m 2 was also an independent risk factor for complications in the entire cohort.…”

“…The literature is ambiguous when it comes to the possible influence of co‐morbidities on postoperative outcomes. Some studies have suggested an independent effect of co‐morbidity on postoperative complications, but others did not find the number of co‐morbidities to influence postoperative outcome. In the present study, the absolute number of co‐morbidities did not affect postoperative outcome, but ASA grade had a strong influence on morbidity and mortality.…”

“…Shin and colleagues reported that type of resection was not associated with postoperative complications. Nevertheless, several other studies have underlined the importance of limiting the extent of surgery in elderly patients when possible.…”

“…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.…”

The effects of epidural versus intravenous patient-controlled analgesia on postoperative outcomes in elderly patients who have undergone gastrectomy: a retrospective trial

“…A study [10] including a meta-analysis and a large randomized clinical trial showed that epidural analgesia leads to better analgesic efficacy and reduces the incidence of postoperative respiratory failure, especially in high-risk patients. Our study also revealed that EPCA had an analgesic effect superior to that of IVPCA in geriatric patients, who have increased perioperative risks after gastrectomy [11]. However, there were no differences between the two groups in the incidences of complications within the first 30 PODs, including cardiovascular complications, cerebrovascular accidents, wound problems, bile leakage, pulmonary complications, or delirium.…”