Published online Feb 21, 2017. doi: 10.3748/wjg.v23.i7.1215
Peer-review started: October 20, 2016
First decision: November 9, 2016
Revised: November 26, 2016
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: February 21, 2017
To investigate the surgical therapies for gastric cancer (GC) patients of age 85 or older in a multicenter survey.
Therapeutic opportunities for elderly GC patients have expanded in conjunction with extended life expectancy. However, the number of cases encountered in a single institution is usually very small and surgical therapies for elderly GC patients have not yet been standardized completely. In the present study, a total of 134 GC patients of age 85 or older who underwent surgery in 9 related facilities were retrospectively investigated. The relationships between surgical therapies and clinicopathological or prognostic features were analyzed.
Eighty-nine of the patients (66%) presented with a comorbidity, and 26 (19% overall) presented with more than two comorbidities. Radical lymphadenectomy was performed in 59 patients (44%), and no patient received pre- or post-operative chemotherapy. Forty of the patients (30%) experienced perioperative complications, but no surgical or perioperative mortality occurred. Laparoscopic surgery was performed in only 12 of the patients (9.0%). Univariate and multivariate analyses of the 113 patients who underwent R0 or R1 resection identified the factors of pT3/4 and limited lymphadenectomy as predictive of worse prognosis (HR = 4.68, P = 0.02 and HR =2.19, P = 0.05, respectively). Non-cancer-specific death was more common in cStage I patients than in cStage II or III patients. Limited lymphadenectomy correlated with worse cancer-specific survival (P = 0.01), particularly in cStage II patients (P < 0.01). There were no relationships between limited lymphadenectomy and any comorbidities, except for cerebrovascular disease (P = 0.07).
Non-cancer-specific death was not negligible, particularly in cStage I, and gastrectomy with radical lymphadenectomy appears to be an effective treatment for cStage II elderly GC patients.
Core tip: Therapeutic opportunities for elderly gastric cancer (GC) patients have expanded. This multicenter study investigated surgical therapies for GC patients of age 85 or older. Cancer-specific and overall survival rates were 100% and 56% in cStage I. The factors of pT3/4 and limited lymphadenectomy were predictive of worse prognosis. Cancer-specific survival in cStage II with radical lymphadenectomy was significantly better, but did not significantly benefit cStage III. Only cerebrovascular disease was related with limited lymphadenectomy. Non-cancer-specific death was not negligible, particularly in cStage I, and gastrectomy with radical lymphadenectomy appeared to be an effective treatment for cStage II elderly patients.