Gastric Cancer

, Volume 21, Issue 4, pp 710–719 | Cite as

The impact of advanced age on short-term outcomes following gastric cancer resection: an ACS-NSQIP analysis

  • Trevor D. Hamilton
  • Alyson L. Mahar
  • Barbara Haas
  • Kaitlyn Beyfuss
  • Calvin H. L. Law
  • Paul J. Karanicolas
  • Natalie G. Coburn
  • Julie Hallet
Original Article



Evidence on short-term outcomes for GC resection in elderly patients is limited by small samples from single-institutions. This study sought to examine the association between advanced age and short-term outcomes of gastrectomy for gastric cancer (GC).


Using ACS-NSQIP data, patients undergoing gastrectomy for GC (2007–2013) were identified. Primary outcome was 30-day major morbidity. Outcomes were compared across age categories (<65, 65–70, 71–75, 76–80, >80 years old). Univariable and multivariable regression was used to estimate the morbidity risk associated with age.


Of 3637 patients, 60.6% were ≥65 years old. Major morbidity increased with age, from 16.3% (<65 years old) to 21.5% (76–80 years old), and 24.1% (>80 years old) (p < 0.001), driven by higher respiratory and infectious events. Perioperative 30-day mortality increased from 1.2% (<65years old) to 6.5% (>80 years old) (p < 0.0001). After adjustments, age was independently associated with morbidity for 76–80 years of age (RR 1.31, 95% CI, 1.08–1.60) and >80 years old (RR 1.49, 95% CI, 1.23–1.81). Predicted morbidity increased by 18.6% in those 75–80 years old and 27.5% in those >80 years old (compared to <65 years old) for total gastrectomy, and by 11.6% and 17.2% for subtotal gastrectomy, for worst case scenario. Morbidity increased by 5.1% in those 75–80 years old and 7.6% in those >80 years old for total gastrectomy, and by 3.1% and 4.7% for subtotal gastrectomy, for best case scenario.


Advanced age, defined as more than 75 years, was independently associated with increased morbidity after GC resection. The magnitude of this impact is further modulated by clinical scenarios. Increased risk in elderly GC patient should be recognized and considered in indications for resection.


Gastric cancer Resection Elderly Morbidity Mortality 


Compliance with ethical standards

Conflict of interest

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. The authors have no conflict of interest to disclose.

Ethical standards

Approval was sought through the Sunnybrook Health Sciences Centre Research Ethics Board, and the study was deemed to be exempt.

Supplementary material

10120_2017_786_MOESM1_ESM.docx (60 kb)
Supplementary material 1 (DOCX 59 kb)


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2017

Authors and Affiliations

  • Trevor D. Hamilton
    • 1
    • 2
  • Alyson L. Mahar
    • 3
  • Barbara Haas
    • 4
    • 5
  • Kaitlyn Beyfuss
    • 5
  • Calvin H. L. Law
    • 4
    • 5
  • Paul J. Karanicolas
    • 4
    • 5
  • Natalie G. Coburn
    • 4
    • 5
  • Julie Hallet
    • 4
    • 5
  1. 1.Department of SurgeryUniversity of British ColumbiaVancouverCanada
  2. 2.Department of SurgeryVancouver General HospitalVancouverCanada
  3. 3.Department of Public Health SciencesQueen’s UniversityKingstonCanada
  4. 4.Department of SurgeryUniversity of TorontoTorontoCanada
  5. 5.Division of General SurgerySunnybrook Health SciencesTorontoCanada

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