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Standard Radical Gastrectomy in Octogenarians and Nonagenarians with Gastric Cancer: Are Short-Term Surgical Results and Long-Term Survival Substantial?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The high incidence of gastric cancer among the octogenarians and nonagenarians (oldest old; age ≥80 years) is emerging as an important management issue. Herein, we report both the short-term outcomes and long-term survival results of standard radical gastrectomy in this group of patients.

Methods

This was a retrospective review of 164 oldest old patients (older group) and 2,258 younger patients (age <80 years; younger group) with gastric cancer who underwent curative resection between January 1994 and December 2006. Clinicopathologic data, long-term survival, and prognostic factors were analyzed.

Results

Clinical tumor stage did not differ between the two groups at the time of diagnosis. Higher Charlson comorbidity index scores (≥5) were observed in the older group than in the younger group; this was associated with higher postoperative morbidity (P = 0.035) and in-hospital mortality rates (P = 0.015) in the older group. At a median follow-up of 37.8 months, the overall survival rate for the older group was lower than that for the younger group (P < 0.001). However, the cumulative incidence of gastric cancer-related deaths was comparable between the two groups. Nodal involvement and metastatic to retrieved lymph node ratio were the only independent predictors of survival in the older group.

Conclusions

Patients in the older group had a higher postoperative morbidity rate but comparable cancer-specific survival. Careful patient selection for gastrectomy is warranted in elderly patients, particularly those with high-grade nodal involvement.

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Acknowledgments

The authors thank Shu-Fang Huang and Yu-Jr Lin for database maintenance and statistical analysis.

Conflict of Interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fushing Street, Kweishan Shiang, Taoyuan, 333, Taiwan

    Jun-Te Hsu, Frank Wang, Tsann-Long Hwang, Yi-Yin Jan & Ta-Sen Yeh

  2. Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan

    Maw-Sen Liu

  3. Graduate Institute of Biomedical Science, Chang Gung University, Taoyuan, Taiwan

    Chee-Jen Chang

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  1. Jun-Te Hsu
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  2. Maw-Sen Liu
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  3. Frank Wang
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  5. Tsann-Long Hwang
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  6. Yi-Yin Jan
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  7. Ta-Sen Yeh
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Corresponding author

Correspondence to Ta-Sen Yeh.

Additional information

This work was partly supported by the Chang Gung Medical Research Program, Taiwan (CMRPG380161) and a grant from the Department of Health, Taiwan (DOH99-TD-C-111-006; PMRPG390071).

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Hsu, JT., Liu, MS., Wang, F. et al. Standard Radical Gastrectomy in Octogenarians and Nonagenarians with Gastric Cancer: Are Short-Term Surgical Results and Long-Term Survival Substantial?. J Gastrointest Surg 16, 728–737 (2012). https://doi.org/10.1007/s11605-012-1835-4

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  • DOI: https://doi.org/10.1007/s11605-012-1835-4

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