Surgical Procedures, Complications, and Prognosis for Gastric Cancer in the Very Elderly (^|^gt;85): A Retrospective Study

Isobe, Taro; Hashimoto, K; Kizaki, Junya; Miyagi, Motoshi; Aoyagi, Keishiro; Koufuji, Kikuo; Shirouzu, Kazuo

doi:10.2739/kurumemedj.59.61

“…More importantly, we found that within the group of elderly patients age ≥80 yrs, surgery could significantly improve OS, especially for early stage patients with resectable proximal gastric carcinoma. This finding is consistent with previous reports focusing on overall elderly patients with gastric cancer, regardless of tumor sites [17,29,30]. Moreover, the survival benefit of surgery was observed in both healthy and less healthy patients with certain comorbidities (CDCI ≥1), indicating that age-associated comorbidities should not be considered as absolute contraindication for surgery [13,31,32].…”

Section: Discussionsupporting

confidence: 91%

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Wang

¹

,

Zhao

²

,

Fairweather

³

et al. 2019

Preprint

0

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Background: High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group. Methods: Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004-2013. Results: Patients age ≥80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p<0.001). However, additional chemotherapy (HR: 0.94, 95% CI: 0.82-1.08, P=0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84-1.13, P=0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51-0.86, P=0.002) was a significant independent prognostic factor, while extensive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22-2.91, P=0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97-1.00, P=0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18%-27% in other programs, P<0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6%-6.6% in other programs, P<0.001; 90-day mortality: 6.2% in AR vs. 13.6%-16.4% in other programs, P<0.001) compared to other facilities. Conclusions: Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs with resectable PGC.

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“…More importantly, we found that within the group of elderly patients age ≥80 yrs, surgery could significantly improve OS, especially for early stage patients with resectable proximal gastric carcinoma. This finding is consistent with previous reports focusing on overall elderly patients with gastric cancer, regardless of tumor sites [17,29,30]. Moreover, the survival benefit of surgery was observed in both healthy and less healthy patients with certain comorbidities (CDCI ≥1), indicating that age-associated comorbidities should not be considered as absolute contraindication for surgery [13,31,32].…”

Section: Discussionsupporting

confidence: 91%

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Wang

¹

,

Zhao

²

,

Fairweather

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group. Methods: Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004-2013. Results: Patients age ≥80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p<0.001), especially in early stage patients. However, additional chemotherapy (HR: 0.94, 95% CI: 0.82-1.08, P =0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84-1.13, P =0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51-0.86, P =0.002) was a significant independent prognostic factor, while extens ive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22-2.91, P =0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97-1.00, P =0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18%-27% in other programs, P <0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6%-6.6% in other programs, P <0.001; 90-day mortality: 6.2% in AR vs. 13.6%-16.4% in other programs, P <0.001) compared to other facilities. Conclusions: Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs with early stage resectable PGC.

show abstract

“…More importantly, we found that within the group of elderly patients age ≥80 yrs, surgery could significantly improve OS, especially for early stage patients with resectable proximal gastric carcinoma. This finding is consistent with previous reports focusing on overall elderly patients with gastric cancer, regardless of tumor sites[17, 29,30]. Moreover, the survival benefit of surgery was observed in both healthy and less healthy patients with certain comorbidities (CDCI ≥1), indicating that age-associated comorbidities should not be considered as absolute contraindication for surgery [13,31,32].…”

Section: Discussionsupporting

confidence: 91%

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Wang

¹

,

Zhao

²

,

Fairweather

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background: High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group. Methods: Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004-2013. Results: Patients age ≥80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p<0.001), especially in early stage patients. However, additional chemotherapy (HR: 0.94, 95% CI: 0.82-1.08, P =0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84-1.13, P =0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51-0.86, P =0.002) was a significant independent prognostic factor, while extens ive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22-2.91, P =0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97-1.00, P =0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18%-27% in other programs, P <0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6%-6.6% in other programs, P <0.001; 90-day mortality: 6.2% in AR vs. 13.6%-16.4% in other programs, P <0.001) compared to other facilities. Conclusions: Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs with early stage resectable PGC.

show abstract

Surgical Procedures, Complications, and Prognosis for Gastric Cancer in the Very Elderly (^|^gt;85): A Retrospective Study

Cited by 15 publications

References 11 publications

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

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