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Survival benefits of gastrectomy compared to conservative observation for older patients with resectable gastric cancer: a propensity score matched analysis

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Abstract

Purpose

Radical gastrectomy is considered the first choice of curative treatment for older patients with gastric cancer (GC). However, there is limited data on the survival benefits of gastrectomy for older patients with GC.

Methods

This was a retrospective observational study where medical records of patients aged ≥ 75 years with clinically resectable primary GC, comprising 115 patients who underwent radical surgery (S group) and 33 patients who received conservative therapy (non-S group) (total cohort) and 44 propensity-matched patients (matched cohort), were reviewed. Survival and independent risk factors, including comorbidities and systemic nutritional and inflammatory statuses, were evaluated.

Results

In the total cohort, the 5-year overall survival (OS) in the S group was significantly higher than that in the non-S group (53.7% vs 19.7%, P < 0.0001). In the matched cohort, the 3-year OS in the S group was significantly higher than that in the non-S group (59.4% vs 15.9%, P < 0.01). Multivariate analysis of the total cohort showed that no surgery was an independent prognostic factor for poor OS (hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.91–7.20, P = 0.0001). In the S group in the total cohort, the multivariate analysis showed that renal disease (HR 2.51, 95% CI 1.23–5.12, P < 0.05) was an independent prognostic factor for poor OS.

Conclusions

Gastrectomy for older patients improved the prognosis; however, careful patient selection is essential, especially among those with renal disease.

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Acknowledgements

The authors thank all members of the Department of Surgery at Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers for their contributions to the discussion section and Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan

    Shuhei Ito, Kippei Ohgaki, Tetsuro Kawazoe, Huanlin Wang, Toshihiko Nakamura, Shinichiro Maehara, Eisuke Adachi, Yoichi Ikeda & Yoshihiko Maehara

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  1. Shuhei Ito
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  2. Kippei Ohgaki
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  3. Tetsuro Kawazoe
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  4. Huanlin Wang
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  7. Eisuke Adachi
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Contributions

Ito: project development, data collection and analysis, manuscript writing and editing. Ohgaki: project development, manuscript editing. Kawazoe: data collection. Wang: data collection. Nakamura: data collection. Maehara: data collection. Adachi: project development, manuscript editing. Ikeda: project development. Maehara: project development.

Corresponding author

Correspondence to Shuhei Ito.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers (Approval Number: 218).

Consent of participation

This was a retrospective observational study carried out using the opt-out method on our hospital website and the outpatient bulletin board. We excluded cases when the patient or their family did not wish to be included in the study.

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The authors declare no competing interests.

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Ito, S., Ohgaki, K., Kawazoe, T. et al. Survival benefits of gastrectomy compared to conservative observation for older patients with resectable gastric cancer: a propensity score matched analysis. Langenbecks Arch Surg 407, 2281–2292 (2022). https://doi.org/10.1007/s00423-022-02511-x

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