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The comparison of prognoses between total and distal gastrectomy for gastric cancer in elderly patients ≥ 80 years old

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Abstract

Purpose

In Japan, the number of distal gastrectomy for patients ≥ 80 years old is increasing, whereas that of total gastrectomy is decreasing. Surgeons seem to avoid total gastrectomy for elderly patients. Total gastrectomy is reported to have a poorer prognosis than distal gastrectomy, and postoperative pneumonia may be involved in the cause.

Methods

The medical records of 39 and 108 patients ≥ 80 years old who underwent total and distal gastrectomy, respectively, at 2 affiliated institutions between 2010 and 2019 were retrospectively reviewed. Prognoses were compared between the two groups, focusing on death from pneumonia.

Results

The median overall survival time after total and distal gastrectomy was 21.3 and 74.1 months, respectively, with a significantly poorer prognosis after total gastrectomy than after distal gastrectomy (p < 0.01, hazard ratio [HR] 2.20, 95% confidence interval [CI] 1.37–3.53). The gastric cancer-specific survival time was significantly worse after total gastrectomy than after distal gastrectomy (p < 0.01, HR 2.73, 95% CI 1.29–5.79). The pneumonia-specific survival time was also significantly worse after total gastrectomy than after distal gastrectomy (p = 0.01, HR 3.44, 95% CI 1.25–9.48).

Conclusions

Patients who underwent total gastrectomy had a poorer prognosis than those who underwent distal gastrectomy, because many patients died of pneumonia early after total gastrectomy.

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Data availability

The datasets used and analyzed during this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank Editage (https://www.editage.jp/) for the English language review.

Funding

This study was funded by Kawasaki Medical School.

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Authors and Affiliations

  1. Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, Japan

    Shunji Endo, Yoshinori Fujiwara, Masaharu Higashida, Hisako Kubota, Hironori Tanaka, Yoshitomo Ito, Toshimasa Okada, Kazuhiko Yoshiatsu & Tomio Ueno

  2. Department of General Surgery, Kawasaki Medical School, 2-6-1, Nakasange, Kita-ku, Okayama, Japan

    Tomoki Yamatsuji

Authors
  1. Shunji Endo
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  2. Tomoki Yamatsuji
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  3. Yoshinori Fujiwara
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  4. Masaharu Higashida
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  5. Hisako Kubota
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  6. Hironori Tanaka
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  7. Yoshitomo Ito
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  9. Kazuhiko Yoshiatsu
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  10. Tomio Ueno
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Contributions

All authors have read and approved the manuscript. SE: protocol/project development, data collection, data analysis, and manuscript writing/editing. TY, YF, MH, and HK: data collection and management. HT, YI, TO, and KY: manuscript writing/editing. TU: protocol/project development and manuscript writing/editing.

Corresponding author

Correspondence to Shunji Endo.

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Conflict of interest

The authors declare no conflicts of interest for this article.

Ethical approval

The protocol for this research project was approved by a suitably constituted Ethics Committee of the institution, and it conforms to the provisions of the Declaration of Helsinki. Committee of Kawasaki Medical School, Approval No. 5083–01. Written informed consent for surgery was obtained from the patients as required by the participating institutions. We used an opt-out recruitment strategy, because the study exclusively analyzed retrospective clinical data without investigation by investigators.

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Endo, S., Yamatsuji, T., Fujiwara, Y. et al. The comparison of prognoses between total and distal gastrectomy for gastric cancer in elderly patients ≥ 80 years old. Surg Today 53, 569–577 (2023). https://doi.org/10.1007/s00595-022-02599-0

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  • DOI: https://doi.org/10.1007/s00595-022-02599-0

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