Abstract
Background
This study was designed to determine the surgical outcomes of gastric cancer in elderly patients. This information can help establish appropriate treatment for these patients.
Methods
A total of 1,193 patients with gastric cancer who underwent gastrectomy between 1995 and 2010 were enrolled in this retrospective study. The clinicopathologic features of 104 elderly patients (aged ≥80 years) were compared with those of 1,089 nonelderly patients.
Results
(1) Tumors located in the lower-third of the stomach, differentiated cancer, and surgery with limited lymph node dissection were more common in elderly patients. However, there was no difference in the proportion of laparoscopic gastrectomy between elderly and nonelderly patients. (2) Although surgical complication rates were similar in the two groups, the operative mortality rate was higher in elderly patients (1.9 %) than in nonelderly patients (0.7 %). (3) Elderly patients had a significantly poorer overall survival rate, whereas the disease-specific survival rates of the two groups were similar. Limited lymph node dissection did not influence the disease-specific survival rate of elderly patients. (4) The median life expectancy of elderly gastric cancer survivors was 9.8 years in patients aged 80–84 years and 6.0 years in those ≥85 years. The patients with limited lymph node dissection had slightly better prognosis.
Conclusions
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.
Similar content being viewed by others
References
United Nations Population Division (2012) World Population Prospects. http://esa.un.org/wpp/. Accessed Dec 2012
Bray F, Jemal A, Grey N et al (2012) Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol 13:790–801
Ministry of Health, Labour and Welfare (2012) Vital Statistics Japan. http://www.mhlw.go.jp/english/database/db-hw/index.html/. Accessed Dec 2012
National Institute of Population and Social Security Research (2012) Population Projection for Japan. http://www.ipss.go.jp/site-ad/index_english/esuikei/gh2401e.asp/. Accessed Dec 2012
Saif MW, Makrilia N, Zalonis A et al (2010) Gastric cancer in the elderly: an overview. Eur J Surg Oncol 36:709–717
Matsuda T, Marugame T, Kamo K et al (2009) Cancer incidence and incidence rates in Japan in 2003: based on data from 13 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) Project. Jpn J Clin Oncol 39:850–858
Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Bertuccio P, Chatenoud L, Levi F et al (2009) Recent patterns in gastric cancer: a global overview. Int J Cancer 125:666–673
Japanese Gastric Cancer Association (1998) Japanese Classification of Gastric Carcinoma, 2nd English Edition. Gastric Cancer 1:10–24
Japanese Gastric Cancer Association (1999) Japanese classification of gastric carcinoma. Kanehara, Tokyo (in Japanese)
Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (version 3). Gastric Cancer 14:113–123
Ministry of Health, Labour, and Welfare (2012) Abridged Life Tables for Japan. http://www.mhlw.go.jp/english/database/db-hw/vs02.html. Accessed Dec 2012
Park DJ, Lee HJ, Kim HH et al (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92:1099–1102
Tekkis PP, McCulloch P, Steger AC et al (2003) Mortality control charts for comparing performance of surgical units: validation study using hospital mortality data. BMJ 326:786–788
Pisanu A, Montisci A, Piu S et al (2007) Curative surgery for gastric cancer in the elderly: treatment decisions, surgical morbidity, mortality, prognosis and quality of life. Tumori 93:478–484
Fujiwara S, Noguchi T, Harada K et al (2012) How should we treat gastric cancer in the very elderly? Hepatogastroenterology 59:620–622
Dittmar Y, Rauchfuss F, Gotz M et al (2012) Impact of clinical and pathohistological characteristics on the incidence of recurrence and survival in elderly patients with gastric cancer. World J Surg 36:338–345. doi:10.1007/s00268-011-1395-x
Wu CW, Lo SS, Shen KH et al (2000) Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg 24:465–472. doi:10.1007/s002689910074
Kim DY, Joo JK, Ryu SY et al (2005) Clinicopathologic characteristics of gastric carcinoma in elderly patients: a comparison with young patients. World J Gastroenterol 11:22–26
Wang JY, Hsieh JS, Huang CJ et al (1996) Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients. J Surg Oncol 63:36–40
Medina-Franco H, Heslin MJ, Cortes-Gonzalez R (2000) Clinicopathological characteristics of gastric carcinoma in young and elderly patients: a comparative study. Ann Surg Oncol 7:515–519
Kitamura K, Yamaguchi T, Taniguchi H et al (1996) Clinicopathological characteristics of gastric cancer in the elderly. Br J Cancer 73:798–802
Fujimoto S, Takahashi M, Ohkubo H et al (1994) Comparative clinicopathologic features of early gastric cancer in young and older patients. Surgery 115:516–520
Jeong SH, Ahn HS, Yoo MW et al (2010) Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgery. J Surg Oncol 101:200–204
Hayashi T, Yoshikawa T, Aoyama T et al (2012) Severity of complications after gastrectomy in elderly patients with gastric cancer. World J Surg 36:2139–2145. doi:10.1007/s00268-012-1653-6
Cho YH, Kim SY, Hong Lee M et al (2012) Comparative analysis of the efficacy and safety of chemotherapy with oxaliplatin plus fluorouracil/leucovorin between elderly patients over 65 years and younger patients with advanced gastric cancer. Gastric Cancer 15:389–395
Lee JL, Kang YK, Kang HJ et al (2008) A randomised multicentre phase II trial of capecitabine vs. S-1 as first-line treatment in elderly patients with metastatic or recurrent unresectable gastric cancer. Br J Cancer 99:584–590
Sakuramoto S, Yamashita K, Watanabe M (2009) Newly emerging standard chemotherapies for gastric cancer and clinical potential in elderly patients. World J Gastrointest Oncol 1:47–54
Watanabe M, Iwatsuki M, Iwagami S et al (2012) Prognostic nutritional index predicts outcomes of gastrectomy in the elderly. World J Surg 36:1632–1639. doi:10.1007/s00268-012-1526-z
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Takeshita, H., Ichikawa, D., Komatsu, S. et al. Surgical Outcomes of Gastrectomy for Elderly Patients with Gastric Cancer. World J Surg 37, 2891–2898 (2013). https://doi.org/10.1007/s00268-013-2210-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-2210-7