Is surgery the best treatment for elderly gastric cancer patients?

Abstract

As the elderly population increases, the number of patients with gastric cancer has also been increasing. Elderly people have various preoperative problems such as malnutrition, high frequency of comorbidities, decreased performance status, and dementia. Furthermore, when surgery is performed, high postoperative complication rates and death from other diseases are also concerns. The goal of surgery in the elderly is that short-term outcomes are comparable to those in nonelderly, and long-term outcomes reach life expectancy. Perioperative problems in the elderly include: (1) Poor perioperative nutritional status; (2) Postoperative pneumonia; and (3) Psychological problems (dementia and postoperative delirium). Malnutrition in the elderly has been reported to be associated with increased postoperative complications and dementia, pointing out the importance of nutritional management. In addition, multidisciplinary team efforts, including perioperative respiratory rehabilitation, preoperative oral care, and early postoperative mobilization programs, are effective in preventing postoperative pneumonia. Furthermore, there are many reports on the usefulness of laparoscopic surgery for the elderly, and we considered that minimally invasive surgery would be the optimal treatment after assessing preoperative risk.

Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer

“…Elderly patients have an increased risk of surgical complications due to underlying diseases, decreased physical performance and malnutrition. Therefore, choosing a reasonable surgical strategy is very important[ 18 ]. Previous results have shown that the incidence of postoperative complications in elderly patients undergoing LG is comparable with that in younger patients, confirming that laparoscopic surgery is a safe method for elderly patients with GC[ 19 , 20 ].…”

Medical disease and ambulatory surgery, new insights in patient selection based on medical disease

“…In patients with gastric cancer, the use of laparoscopic gastrectomy has become widespread as a minimally invasive procedure and with reduction in postoperative complications [8]. We are probably not there yet where a fully ambulatory procedure for gastric cancer can be implemented but the emerging widespread use of laparoscopic surgery for this disease may be the first step in that direction.…”

Enhancing surgical outcomes in elderly gastric cancer patients: the role of comprehensive preoperative assessment and support

“…While surgery remains the primary treatment, the advanced age of these patients often corresponds with increased surgical risks and comorbidities, necessitating a nuanced treatment approach. It is critical to balance the potential benefits of surgery against the risks of postoperative complications in this demographic [ 4 – 8 ]. Effective management of these complications is essential not only to improve immediate surgical outcomes but also to reduce non-cancer mortality, further underscoring the importance of postoperative care [ 9 ].…”

“…For instance, previous study demonstrated that perioperative geriatric care significantly reduces hospital stays and ICU usage in these patients [ 10 ], underscoring the value of comprehensive preoperative assessments. This approach is crucial in addressing the diverse medical needs of this population and ensuring favorable surgical outcomes [ 4 , 11 ].…”