Feasibility and Effectiveness of Gastrectomy for Elderly Gastric Cancer Patients

Abstract

Background/Aim: The benefits of gastrectomy for elderly gastric cancer (GC) patients remain unknown. The aim of this study was to evaluate the validity of gastrectomy. Patients and Methods: Patients who had R0 or R1 resection and diagnosed as pathological Stage I-III GC were enrolled in this study. Patients were classified according to age: Elderly group (≥80 years old), non-Elderly group (70-79 years old), Standard group (≤69 years old). Results: As the age raised, the number of comorbidities increased and patients had a worse physical status. Operative procedure and postoperative complications of the Elderly group were similar to that of the non-Elderly group. The overall survival was similar in pathological Stages I and III between the Elderly and non-Elderly groups, while the Stage II Elderly group had shorter overall survival. Also, the Elderly group did not undergo adjuvant chemotherapy compared to other groups. Conclusion: Gastrectomy can be performed safely in elderly patients following gastrectomy, survival of elderly patients was similar to non-elderly patients. Therefore, gastrectomy is an acceptable treatment for elderly patients in good condition. The incidence of Gatric cancer has declined over the past decades (1); however, it is still one of the most common cancers worldwide (2). Gastrectomy is the main treatment for gastric cancer, but it might associate with severe postoperative gastrointestinal symptoms. Previous reports have shown that postoperative morbidity leads to poor prognosis, especially in elderly patients (3, 4). Aging is accompanied by a decline in the function of critical organs (5, 6). Postoperative morbidity and mortality increases as the age increases. Moreover, elderly patients often have several comorbidities at the time of diagnosis that sometimes affect survival (7, 8). Therefore, it is difficult to predict surgical risk, since physical status varies greatly among elderly individuals. The rate of gastrectomy in the elderly is increasing (9). Previous articles have shown that gastrectomy can be performed safely in elderly patients as in non-elderly patients (10, 11). However, following gastrectomy, pneumonia often develops leading to death of elderly patients (12). Also, elderly patients are likely to develop malnutrition (13). Therefore, it is still unclear whether gastrectomy improves the overall survival of elderly patients. The aim of this study was to evaluate whether gastrectomy is beneficial for elderly gastric cancer patients. Patients and Methods Study design. A single institutional retrospective cohort study was performed at the Kita-Harima Medical Center Hospital from January 2014 to December 2017. All patients who had R0 or R1 resection and diagnosed as pathological Stage I-III were enrolled into this study. Since younger patients tend to have less comorbidities and a better physical status, those under 70 years were considered as standard controls. We defined those over 80 years old as the Elderly group and those between 70-79 years old as the non-Elderly group. C...

Risk Factors for Overall Complications and Remote Infection After Gastrectomy in Elderly Gastric Cancer Patients

“…Of note, a lower hemoglobin level and performing total gastrectomy could significantly be associated with the occurrence of postoperative remote infections such as pneumonia. The overall complication rate after gastrectomy in GC patients over 80 years of age was reported to be 30.8% in a recent study (18). The present study demonstrated that complications with a Clavien-Dindo classification≥grade II were observed in 24.8% of patients, which is consistent with the results of previous reports on elderly GC patients (19,20).…”

“…Notably, postoperative pneumonia as a remote infection was observed in six patients (5.9%). Previous reports showed that postoperative pneumonia occurred in 3-10% of patients and was the most common complication in elderly patients (18)(19)(20). Pneumonia is one of the most important complications after gastrectomy, which could affect the period of hospital stay or the quality of life after discharge in elderly GC patients.…”

Gastroesophageal adenocarcinoma in older adults: A comprehensive narrative review of management by the Young International Society of Geriatric Oncology

“…This is supported by Fujiwara et al who prospectively enrolled 448 patients undergoing gastrectomy; more postoperative complications (especially respiratory complications), in-hospital deaths, and worse OS were observed in patients aged ≥80 [44]. Despite these findings, patient selection and optimization of fitness before gastrectomy are key factors to ensure successful and safe surgery in older patients [45,46].…”

The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years

“…In general, if ESD results in non-curative resection, additional gastrectomy should be recommended [ 14 ]. However, age is a potential risk factor for morbidity (10.1–19.4%), although the mortality rate (0–2.2%) does not significantly differ between the elderly and the non-elderly patients [ 15 , 16 , 17 , 18 , 19 ]. Other reports have shown that myocardial infarction and diabetes are risk factors for increased mortality after gastrectomy [ 20 , 21 ].…”