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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Changing trends in gastric and colorectal cancer among surgical patients over 85 years old: A multicenter retrospective study, 2001–2021
Ke Chen, Ming Li, Ran Xu, Ping-Ping Zheng, Meng-Ding Chen, Liang Zhu, Wen-Bin Wang, Zheng-Guang Wang
Ke Chen, Department of Vascular Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
Ming Li, College of Pharmacy of Anhui Medical University, Hefei 230001, Anhui Province, China
Ran Xu, Department of General Surgery, First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
Ping-Ping Zheng, Department of General Practice, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
Meng-Ding Chen, Zheng-Guang Wang, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 231000, Anhui Province, China
Liang Zhu, Department of General Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Wen-Bin Wang, Department of General Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 231000, Anhui Province, China
Author contributions: Chen K and Ming Li and Ran Xu contributed equally to this work; Chen K, Li M, Xu R, Zheng PP, Chen MD and Zhu L collected data; Chen K, Li M and Xu R wrote the manuscript; Zheng PP, Chen MD and Zhu L analyzed the data; Wang WB and Wang ZG designed ideas.
Institutional review board statement: The study was reviewed and approved by the Clinical Medical Research Ethics Committee of the First Affiliated Hospital of Anhui Medical University (PJ2023-07-56).
Conflict-of-interest statement: All those named as authors have made a sufficient contribution to the final manuscript for submission. All authors declare no conflict of interest, and agree on consent to be listed as coauthors.
Data sharing statement: Data will be made available on request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Zheng-Guang Wang, MD, PhD, Chief Doctor, Professor, Research Scientist, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230001, Anhui Province, China. wangzhengguang@ahmu.edu.cn
Received: April 23, 2023
Peer-review started: April 23, 2023
First decision: May 27, 2023
Revised: May 31, 2023
Accepted: July 6, 2023
Article in press: July 6, 2023
Published online: August 27, 2023
ARTICLE HIGHLIGHTS
Research background
An increasing number of patients over 85 years old are receiving surgical treatment for gastric cancer (GC) and colorectal cancer (CRC). The number of surgical patients in 2016-2021 was nearly eight times that of patients in 2001-2005 in China. TNM stage and the number of tumor prone sites changed significantly, and the incidence of perioperative complications significantly decreased. Perioperative mortality in the last period was 71.97% lower than it was in the first period. Laparoscopic technology is increasingly used in elderly patients with CRC, but its uptake in the field of GC is slow. In patients with TNM I stage, radical rather than limited lymphadenectomy should be prioritized.
Research motivation
Whether patients over 85 years old with gastrointestinal cancer should undergo surgery remains controversial.
Research objectives
describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan.
Research methods
Retrospective analysis.
Research results
Only 14 GC patients underwent laparoscopic surgery where 219 CRC patients had this procedure. Cardia and esophagogastric junction cancer increased in GC patients, and the proportion of sigmoid colon cancer decreased in CRC patients. Pulmonary infection gradually became the most common postoperative complication, its incidence in period 4 reached 48.79%. However, the incidence of anastomotic leakage decreased from 26.79% to 9.38% (P < 0.01). Additionally, 30-d mortality significantly decreased from 32.14% to 9.01%. Increases were observed in 5-year OS in GC patients from period 1 to period 4 (18.18% vs 33.32%, respectively) and CRC patients (0 vs 36.32%, respectively). DFS also increased in GC and CRC patients (7.14% vs 27.74% and 0 to 36.03%, respectively). The average survival time of GC patients following radial lymphadenectomy was higher than in patients that underwent limited lymphadenectomy (26 vs 22 mo, respectively), the same was seen in CRC patients (44 vs 33 mo, respectively). This advantage was particularly evident in patients with TNM I, but not in patients with TNM II/III period cancer.
Research conclusions
The safety as well as effectiveness of surgery in ultra-elderly patients is increasing. Radical lymphadenectomy has advantages in patients with TNM I gastrointestinal cancer, but not TNM II/III.
Research perspectives
Gastric cancer, colorectal cancer.
