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Postoperative Long-Term Outcomes in Elderly Patients with Gastric Cancer and Risk Factors for Death from Other Diseases

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Abstract

Background

Elderly patients with gastric cancer are frequently treated surgically in current clinical practice. Although several studies have investigated short-term outcomes after gastrectomy in elderly patients, most did not evaluate long-term outcomes.

Methods

We analyzed 1154 consecutive patients who underwent curative gastrectomy for gastric cancer between 2001 and 2013. We classified them into two groups: the elderly group (n = 241), consisting of patients aged ≥75 years, and the non-elderly group (n = 913), consisting of patients aged <75 years, and compared the short- and long-term outcomes between the two groups. The risk factors for death from other diseases in elderly patients were also examined.

Results

Although the incidence of postoperative pneumonia was significantly higher in the elderly group (P < 0.001), the proportion of overall postoperative complications did not differ significantly between the two groups (P = 0.097). The disease-specific survival was similar between the two groups (P = 0.743), whereas the overall survival in the elderly group was significantly shorter than that in the non-elderly group (P < 0.001) because of a higher incidence of death from other diseases throughout all gastric cancer stages. Multivariate analysis revealed that a low preoperative prognostic nutrition index (PNI) and multiple comorbidities were significant risk factors for death from other diseases within 5 years in the elderly group.

Conclusions

Despite acceptable short-term outcomes, long-term outcomes in elderly patients with gastric cancer were poor due to the high incidence of death from other diseases. Indications for surgery in elderly patients with a low PNI or multiple comorbidities should be considered carefully.

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References

  1. Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386

    Article  CAS  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. Colvin H, Mizushima T, Eguchi H et al (2017) Gastroenterological surgery in Japan: the past, the present and the future. Ann Gastroenterol Surg 1:5–10

    Article  Google Scholar 

  4. Hashimoto T, Kurokawa Y, Mori M et al (2018) Update on the treatment of gastric cancer. JMA J 1:40–49

    Article  Google Scholar 

  5. Mukai Y, Kurokawa Y, Takiguchi S et al (2017) Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume? Ann Gastroenterol Surg 1:186–192

    Article  Google Scholar 

  6. Katai H, Sasako M, Sano T et al (2004) Gastric cancer surgery in the elderly without operative mortality. Surg Oncol 13:235–238

    Article  Google Scholar 

  7. Schlesinger-Raab A, Mihaljevic AL, Egert S et al (2016) Outcome of gastric cancer in the elderly: a population-based evaluation of the Munich Cancer Registry. Gastric Cancer 19:713–722

    Article  Google Scholar 

  8. Takeuchi D, Koide N, Suzuki A et al (2015) Postoperative complications in elderly patients with gastric cancer. J Surg Res 198:317–326

    Article  Google Scholar 

  9. Liang YX, Deng JY, Guo HH et al (2013) Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years. World J Gastroenterol 19:6568–6578

    Article  Google Scholar 

  10. Mikami J, Kurokawa Y, Miyazaki Y et al (2015) Postoperative gastrectomy outcomes in octogenarians with gastric cancer. Surg Today 45:1134–1138

    Article  Google Scholar 

  11. Orsenigo E, Tomajer V, Palo SD et al (2007) Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer 10:39–44

    Article  Google Scholar 

  12. Takeshita H, Ichikawa D, Komatsu S et al (2013) Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg 37:2891–2898. https://doi.org/10.1007/s00268-013-2210-7

    Article  PubMed  Google Scholar 

  13. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123

    Article  Google Scholar 

  14. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 40:205–213

    Article  Google Scholar 

  16. Katayama H, Kurokawa Y, Nakamura K et al (2016) Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today 46:668–685

    Article  Google Scholar 

  17. Hamakawa T, Kurokawa Y, Mikami J et al (2016) Risk factors for postoperative complications after gastrectomy in gastric cancer patients with comorbidities. Surg Today 46:224–228

    Article  Google Scholar 

  18. Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85:1001–1005

    CAS  PubMed  Google Scholar 

  19. Yamada H, Shinohara T, Takeshita M et al (2013) Postoperative complications in the oldest old gastric cancer patients. Int J Surg 11:467–471

    Article  Google Scholar 

  20. Takama T, Okano K, Kondo A et al (2015) Predictors of postoperative complications in elderly and oldest old patients with gastric cancer. Gastric Cancer 18:653–661

    Article  CAS  Google Scholar 

  21. Miki Y, Makuuchi R, Tokunaga M et al (2016) Risk factors for postoperative pneumonia after gastrectomy for gastric cancer. Surg Today 46:552–556

    Article  Google Scholar 

  22. Shaker R, Easterling C, Kern M et al (2002) Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 122:1314–1321

    Article  Google Scholar 

  23. Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762

    Article  Google Scholar 

  24. Saidi RF, Bell JL, Dudrick PS (2004) Surgical resection for gastric cancer in elderly patients: is there a difference in outcome? J Surg Res 118:15–20

    Article  Google Scholar 

  25. Endo S, Shimizu Y, Ikenaga M et al (2017) Survival benefit of gastrectomy for gastric cancer in patients ≥ 85 years old: a retrospective propensity score-matched analysis. Surgery 161:984–994

    Article  Google Scholar 

  26. Ueno D, Matsumoto H, Kubota H et al (2017) Prognostic factors for gastrectomy in elderly patients with gastric cancer. World J Surg Oncol 15:1131–1136

    Article  Google Scholar 

  27. Ramesh HS, Pope D, Gennari R et al (2005) Optimising surgical management of elderly cancer patients. World J Surg Oncol 3:17

    Article  Google Scholar 

  28. Saif MW, Makrilia N, Zalonis A et al (2010) Gastric cancer in the elderly: an overview. Eur J Surg Oncol 36:709–717

    Article  CAS  Google Scholar 

  29. Ouchi Y, Rakugi H, Arai M et al (2017) Redefining the elderly as aged 75 years and older: proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int 17:1045–1047

    Article  Google Scholar 

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Acknowledgements

The authors declare that this study was not funded.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Tadayoshi Hashimoto, Yukinori Kurokawa, Jota Mikami, Tsuyoshi Takahashi, Yasuhiro Miyazaki, Koji Tanaka, Tomoki Makino, Makoto Yamasaki, Masaaki Motoori, Yutaka Kimura, Kiyokazu Nakajima & Yuichiro Doki

  2. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Masaaki Motoori

  3. Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan

    Yutaka Kimura

  4. Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan

    Masaki Mori

Authors
  1. Tadayoshi Hashimoto
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  2. Yukinori Kurokawa
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  3. Jota Mikami
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Correspondence to Yukinori Kurokawa.

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Hashimoto, T., Kurokawa, Y., Mikami, J. et al. Postoperative Long-Term Outcomes in Elderly Patients with Gastric Cancer and Risk Factors for Death from Other Diseases. World J Surg 43, 2885–2893 (2019). https://doi.org/10.1007/s00268-019-05109-5

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  • DOI: https://doi.org/10.1007/s00268-019-05109-5

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