Background

The incidence of gastric cancer in elderly patients is increasing and the choice of treatment is controversial among physicians, oncologists and surgeons. In addition, about 2/3 of patients present a neoplastic recurrence after a curative intervention [1]. The aim of this study is the analysis of the factors which influence the risk of recurrence in elderly patients.

Materials and methods

All patients who received a gastrectomy for adenocarcinoma in our surgical department from January 1998 to December 2002 were admitted to the study. Inclusion criteria were: a) Curative resection (R0); b)no metastases before surgery; c)no other primitive neoplasms; d)consensus of the patient for a follow-up of 5 years. Recurrence was indicated as haematogenous, peritoneal or locoregional on the basis of the first site of metastases. Patients were divided into two groups by age: cut-off was considered 70 years old.

Results

48 patients were admitted to the study : 26 male and 22 female patients, with a average age of 61,9 years old (37 – 80). 16 patients were ≥ 70 years old.

During a 5-year follow-up we observed in the older group 9 recurrences (56%) : in 44% cases there was a peritoneal recurrence, in 33% a haematogenous recurrence and in 23% of patients a locoregional disease. In patients < 70 years old we observed a peritoneal recurrence only in 5 % of cases. (Table 1).

Table 1 Recurrence site for age
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Factors correlated with a neoplastic recurrence in the older group were: pTNM III at diagnosis (78% vs 43%), subtotal gastrectomy (65% vs 56%), Lauren diffuse adenocarcinoma (45% vs 33%) and a Linfonodal ratio (LNR) ≥ 20 % (89% vs 30%).(Table 2)

Table 2 Factors associated with recurrence in patients ≥ 70 years
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Conclusions

In elderly patients we observed a neoplastic recurrence in 56% of cases: first site of disease was peritoneum (44% ) then haematogenous recurrence (33%).In younger patients, instead, a locoregional recurrence was more frequent (62% vs 23%). Predictive factors of neoplastic recurrence in elderly patients were: pTNM III, subtotal gastrectomy, Lauren diffuse adenocarcinoma and a LNR ≥ 20 %. These factors can help the surgeon and the oncologist to identify, in a population of elderly gastrectomized patients, who needs a closer follow-up due to a higher risk of recurrence, in order to permit a more aggressive therapy.