|
1
|
Ramírez-Giraldo C, Avendaño-Morales V, Van-Londoño I, Melo-Leal D, Camargo-Areyanes MI, Venegas-Sanabria LC, Vargas JPV, Aguirre-Salamanca EJ, Isaza-Restrepo A. Lymph Node Dissection of Choice in Older Adult Patients with Gastric Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:7678. [PMID: 39768601 PMCID: PMC11678213 DOI: 10.3390/jcm13247678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 10/27/2024] [Accepted: 10/28/2024] [Indexed: 01/11/2025] Open
Abstract
Background: Although the current literature has shown an increasing interest in surgical treatment of gastric cancer (GC) in older adults in recent years, there is still no consensus on proper management in this subgroup of patients. This study was designed with the objective of evaluating the current evidence that compares limited lymph node dissection with extended lymph node dissection in older adult patients (≥65 years) coursing with resectable GC. Methods: A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. All studies before 2018 were selected using a systematic review by Mogal et al. Studies were eligible for this meta-analysis if they were randomized controlled trials or non-randomized comparative studies comparing limited lymph node dissection versus extended lymph node dissection in patients with resectable GC taken to gastrectomy. Results: Seventeen studies and a total of 5056 patients were included. There were not any statistically significant differences in OS (HR = 1.04, CI95% = 0.72-1.51), RFS (HR = 0.92, CI95% = 0.62-1.38), or CSS (HR = 1.24, CI95% = 0.74-2.10) between older adult patients taken to limited and extended lymphadenectomy in addition to gastrectomy as the current surgical treatment for GC. Although a higher rate of major complications was observed in the extended lymphadenectomy group, this difference was not statistically significant in incidence between both groups of patients (OR = 1.92, CI95% = 0.75-4.91). Conclusions: Limited lymphadenectomy must be considered as the better recommendation for surgical treatment for GC in older adult patients, considering the oncological outcomes and lower rates of complications compared with more radical lymph node dissections.
Collapse
Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | - Violeta Avendaño-Morales
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
| | - Isabella Van-Londoño
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | - Daniela Melo-Leal
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | | | - Luis Carlos Venegas-Sanabria
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| | | | | | - Andrés Isaza-Restrepo
- Hospital Universitario Mayor-Méderi, Bogotá 111411, Colombia; (V.A.-M.); (L.C.V.-S.); (E.J.A.-S.); (A.I.-R.)
- Universidad del Rosario, Bogotá 111221, Colombia; (I.V.-L.); (D.M.-L.); (M.I.C.-A.); (J.P.V.V.)
| |
Collapse
|
|
2
|
Iida M, Takeda S, Yamamoto T, Nakashima C, Nishiyama M, Watanabe Y, Shindo Y, Tokumitsu Y, Tomochika S, Nakagami Y, Takahashi H, Nagano H. Risk factors for infectious complications after gastrectomy in older patients. Exp Ther Med 2024; 28:319. [PMID: 38939176 PMCID: PMC11208990 DOI: 10.3892/etm.2024.12608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/29/2024] [Indexed: 06/29/2024] Open
Abstract
The present study aimed to identify preoperative and perioperative risk factors for postoperative infectious complications in older patients with gastric cancer. The present retrospective study included 504 patients with gastric cancer aged >65 years who underwent radical gastrectomy. After determining the cutoff values for various perioperative factors in the receiver operating characteristic curve analysis, preoperative and perioperative risk factors for the development of infectious complications after gastrectomy were examined using logistic regression analysis. Of the 504 patients who underwent gastrectomy, 95 (18.8%) developed infectious complications of grade II-V based on the Clavien-Dindo classification. In an analysis restricted to preoperative factors, male sex, low prognostic nutritional index, high visceral fat area and total gastrectomy were independent risk factors for infectious complications after gastrectomy. Among all perioperative factors, a low prognostic nutritional index and long operative duration were identified as independent risk factors for infectious complications after gastrectomy. The patients were divided into five groups according to the number of positive preoperative risk factors for infectious complications, and the incidence of infectious complications differed among the five groups (0 factors, 6.7%; 1 factor, 10.4%; 2 factors, 18.9%; 3 factors, 27.8%; and 4 factors, 47.6%; P<0.001). Older patients with gastric cancer who have a number of preoperative risk factors require careful consideration of the indication for gastrectomy and a shorter operative time to reduce infectious complications.
Collapse
Affiliation(s)
- Michihisa Iida
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Tsunenori Yamamoto
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Chiyo Nakashima
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Mitsuo Nishiyama
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yusaku Watanabe
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shinobu Tomochika
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yuki Nakagami
- Department of Data Science, Faculty of Data Science, Shimonoseki City University, Shimonoseki, Yamaguchi 751-8510, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| |
Collapse
|
|
3
|
Endo S, Higashida M, Furuya K, Yano S, Okada T, Yoshimatsu K, Fujiwara Y, Ueno T. Prognostic factors for gastric cancer patients aged ≥ 85 years. BMC Cancer 2024; 24:745. [PMID: 38890565 PMCID: PMC11186202 DOI: 10.1186/s12885-024-12512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND As gastric cancer patients aged ≥ 85 years have a short life expectancy and often die from other diseases such as pneumonia, indications for surgery are controversial. In this study, we retrospectively analyzed the prognostic factors of elderly patients with gastric cancer who are candidates for curative gastrectomy. METHODS Among 114 patients aged ≥ 85 years with gastric cancer at our hospital between 2010 and 2019, prognostic factors were examined using the Cox proportional hazards model in 76 patients excluding those with cStage IVB or endoscopic submucosal dissection. We also analyzed the factors of pneumonia death. RESULTS cStage was I/IIA/IIB/III/IVA in 37/6/14/14/5 patients, respectively. Treatment included distal gastrectomy in 28 patients, total gastrectomy in 6, local resection in 9, others in 3, and no surgery in 30. In univariate analyses of overall survival, Eastern Cooperative Oncology Group Performance Status, physiological score of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Onodera's prognostic nutritional index, cStage, and treatment were prognostic factors. In a multivariate analysis, POSSUM physiological score, cStage, treatment method {no surgery vs. distal gastrectomy: hazard ratio (HR) 5.78, 95% confidence interval (CI) 2.33-14.3}, (total gastrectomy vs. distal gastrectomy: HR 4.26, 95% CI 1.22-14.9) were independent prognostic factors. In univariate analyses of pneumonia-specific survival, treatment (total gastrectomy vs. distal gastrectomy: HR 6.98, 95% CI 1.18-41.3) was the only prognostic factor. CONCLUSIONS The prognosis of distal gastrectomy was better than that of non-surgery even in patients aged ≥ 85 years. However, total gastrectomy was considered to be avoidable due to the high rate of postoperative pneumonia death.
Collapse
Affiliation(s)
- Shunji Endo
- Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan.
| | - Masaharu Higashida
- Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Kei Furuya
- Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Shuya Yano
- Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Toshimasa Okada
- Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Kazuhiko Yoshimatsu
- Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Yoshinori Fujiwara
- Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan
| | - Tomio Ueno
- Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan
| |
Collapse
|
|
4
|
Szor DJ, Pereira MA, Ramos MFKP, Tustumi F, Dias AR, Zilberstein B, Ribeiro Jr U. Preoperative albumin-bilirubin score is a prognostic factor for gastric cancer patients after curative gastrectomy. World J Gastrointest Surg 2023; 15:1125-1137. [PMID: 37405095 PMCID: PMC10315126 DOI: 10.4240/wjgs.v15.i6.1125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/21/2023] [Accepted: 04/17/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Albumin-bilirubin (ALBI) score is an indicator of liver dysfunction and is useful for predicting prognosis of hepatocellular carcinomas. Currently, this liver function index has been used to predict prognosis in other neoplasms. However, the significance of ALBI score in gastric cancer (GC) after radical resection has not been elucidated.
AIM To evaluate the prognostic value of the preoperative ALBI status in patients with GC who received curative treatment.
METHODS Patients with GC who underwent curative intended gastrectomy were retrospectively evaluated from our prospective database. ALBI score was calculated as follows: (log10 bilirubin × 0.660) + (albumin × -0.085). The receiver operating characteristic curve with area under the curve (AUC) was plotted to evaluate the ability of ALBI score in predicting recurrence or death. The optimal cutoff value was determined by maximizing Youden’s index, and patients were divided into low and high-ALBI groups. The Kaplan-Meier curve was used to analyze the survival, and the log-rank test was used for comparison between groups.
RESULTS A total of 361 patients (235 males) were enrolled. The median ALBI value for the entire cohort was -2.89 (IQR -3.13; -2.59). The AUC for ALBI score was 0.617 (95%CI: 0.556-0.673, P < 0.001), and the cutoff value was -2.82. Accordingly, 211 (58.4%) patients were classified as low-ALBI group and 150 (41.6%) as high-ALBI group. Older age (P = 0.005), lower hemoglobin level (P < 0.001), American Society of Anesthesiologists classification III/IV (P = 0.001), and D1 lymphadenectomy P = 0.003) were more frequent in the high-ALBI group. There was no difference between both groups in terms of Lauren histological type, depth of tumor invasion (pT), presence of lymph node metastasis (pN), and pathologic (pTNM) stage. Major postoperative complication, and mortality at 30 and 90 days were higher in the high-ALBI patients. In the survival analysis, the high-ALBI group had worse disease-free survival (DFS) and overall survival (OS) compared to those with low-ALBI (P < 0.001). When stratified by pTNM, the difference between ALBI groups was maintained in stage I/II and stage III CG for DFS (P < 0.001 and P = 0.021, respectively); and for OS (P < 0.001 and P = 0.063, respectively). In multivariate analysis, total gastrectomy, advanced pT stage, presence of lymph node metastasis and high-ALBI were independent factors associated with worse survival.
CONCLUSION The preoperative ALBI score is able to predict the outcomes of patients with GC, where high-ALBI patients have worse prognosis. Also, ALBI score allows risk stratification of patients within the same pTNM stages, and represents an independent risk factor associated with survival.
Collapse
Affiliation(s)
- Daniel Jose Szor
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil
| | - Marina Alessandra Pereira
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil
| | - Marcus Fernando Kodama Pertille Ramos
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil
| | - Francisco Tustumi
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil
| | - Andre Roncon Dias
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil
| | - Bruno Zilberstein
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil
| | - Ulysses Ribeiro Jr
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246000, Brazil
| |
Collapse
|
|
5
|
Okada T, Mikamo T, Hamamoto W, Iwamoto T, Okamoto T, Maeda K, Yanagitani A, Tanaka K, Isomoto H, Yamaguchi N. Modified BEST-J Score Model Predicts Bleeding after Endoscopic Submucosal Dissection with Fewer Factors. Cancers (Basel) 2022; 14:cancers14225555. [PMID: 36428648 PMCID: PMC9688376 DOI: 10.3390/cancers14225555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
This study constructed a simplified post-endoscopic submucosal dissection (ESD) prediction model with a prognostic nutritional index (PNI). A total of 449 patients who underwent gastric ESD was included, divided with a ratio of 2:1, and assigned to the model or validation cohort. A prediction model of post-ESD (modified BEST-J score) was constructed using the model cohort. The modified BEST-J score was evaluated by comparing its accuracy to the BEST-J score in the validation cohort. Within 4 weeks of ESD, melena, hematemesis, or a 2 g/dL or greater decrease in hemoglobin level that required esophagogastroduodenoscopy was defined as post-ESD bleeding. In the model cohort, 299 patients were enrolled and 25 (8.4%) had post-ESD bleeding. Independent risk factors for post-ESD bleeding were use of P2Y12RA, tumor size > 30 mm, location of lesion at lower one-third of the stomach, and PNI ≤ 47.9. Constructing the modified BEST-J score based on these variables, the sensitivity, specificity, and positive likelihood ratio were 73.9%, 78.1%, and 3.37. When comparing the modified BEST-J score to the BEST-J score in the validation cohort, no significant difference was observed by ROC-AUC (0.77 vs. 0.75, p = 0.81). Modified BEST-J score can predict post-ESD bleeding more simply, with the same accuracy as the BEST-J score.
Collapse
Affiliation(s)
- Tomoyuki Okada
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
- Correspondence: ; Tel.: +0857-26-2271
| | - Tsuyoshi Mikamo
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Wataru Hamamoto
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Taku Iwamoto
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | | | - Kazunori Maeda
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | | | - Kiwamu Tanaka
- Tottori Prefectural Central Hospital, Tottori 680-0901, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Naoyuki Yamaguchi
- Department of Endoscopy, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| |
Collapse
|
|
6
|
Yang W, Fang Y, Niu Y, Sun Y. A predictive model for early death in elderly patients with gastric cancer: A population-based study. Front Oncol 2022; 12:972639. [PMID: 36072801 PMCID: PMC9444320 DOI: 10.3389/fonc.2022.972639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe mean age of gastric cancer (GC) patients has increased due to the aging society. Elderly GC patients with poor physical status tend to develop complications during the treatment courses, which cause early death. This study aimed to identify risk factors and establish nomograms for predicting total early death and cancer-specific early death in elderly GC patients.MethodsData for elderly GC patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were randomly assigned to a training cohort and a validation cohort. The univariate logistic regression model and backward stepwise logistic regression model were used to identify independent risk factors for early death. Nomograms were constructed to predict the overall risk of early death and their performance was validated by receiver operating characteristic (ROC) curve, calibration curve, decision curve analyses (DCA), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) in both training and validation cohorts.ResultsAmong the 3102 enrolled patients, 1114 patients died within three months from the first diagnosis and 956 of them died due to cancer-specific causes. Non-Asian or Pacific Islander (API) race, non-cardia/fundus or lesser/greater curvature, higher AJCC stage, no surgery and no chemotherapy were all related to a high risk of both all-cause early death and cancer-specific early death. Higher T stage and N0 stage were only positively related to total early mortality, while liver metastasis was only positively related to cancer-specific early mortality. Based on these identified factors, two nomograms were developed for predicting the risk of all-cause and cancer-specific early death, which showed good performance with the AUC of the nomograms were 0.775 and 0.766, respectively. The calibration curves, DCAs, NRI, and IDI also confirmed the value of these nomograms.ConclusionsThese nomogram models were considered a practical tool to identify the early death of elderly GC patients and help provide a more individualized treatment strategy.
Collapse
Affiliation(s)
- Wenwei Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuting Fang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaru Niu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongkun Sun
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China
- *Correspondence: Yongkun Sun,
| |
Collapse
|
|
7
|
Choi Y, Kim N, Kim KW, Jo HH, Park J, Yoon H, Shin CM, Park YS, Lee DH. Gastric cancer in older adult patients: a retrospective study and literature review. Ann Geriatr Med Res 2022; 26:33-41. [PMID: 35298880 PMCID: PMC8984166 DOI: 10.4235/agmr.21.0144] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background With increasing life expectancy, the incidence of gastric cancer (GC) in older adults is increasing. This study analyzed differences in GC characteristics according to age and sex among patients who underwent surgical treatment for GC. Methods A total of 2,983 patients diagnosed with gastric adenocarcinoma who underwent surgical treatment at Seoul National University Bundang Hospital between 2003 and 2017 were classified into three groups: I (<65 years, n=1,680), II (60–74 years, n=919), and III (≥75 years, n=384). We compared the baseline clinical characteristics, pathological characteristics of the tumor, overall and GC-specific survival rates, and associated risk factors between the groups. Results Cancer of the distal third of the stomach (p<0.001), with intestinal-type histology (p<0.001), and with p53 overexpression (p=0.004) were more common in groups II and III than in group I, and the proportion of intestinal-type GC increased with age. The cancer type, lymph node metastasis, and cancer stage did not differ significantly. In terms of overall survival, survival decreased with increasing age (p<0.001), but this difference decreased significantly for GC-specific survival. Cox multivariate analyses revealed age, histologic type (diffuse or mixed type), and advanced cancer stage (p=0.002, 0.001, and <0.001, respectively) as risk factors for GC-related mortality. Conclusion Age itself was found to be one of the most important prognostic factors for overall and disease-specific survival in elderly GC patients, along with cancer stage.
Collapse
Affiliation(s)
- Yonghoon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyeong Ho Jo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jaehyung Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
|
8
|
Liu X, Xue Z, Yu J, Ma Z, Kang W, Ye X, Li Z. Risk factors for cancer-specific survival in elderly gastric cancer patients after curative gastrectomy. Nutr Res Pract 2022; 16:604-615. [PMID: 36238382 PMCID: PMC9523207 DOI: 10.4162/nrp.2022.16.5.604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/29/2021] [Accepted: 01/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m2. Multivariate analysis indicated that a BMI ≤ 20.6 kg/m2 (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS. CONCLUSIONS Low BMI (≤ 20.6 kg/m2), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.
Collapse
Affiliation(s)
- Xiao Liu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
|
9
|
Kawaguchi Y, Akaike H, Shoda K, Furuya S, Hosomura N, Amemiya H, Kawaida H, Kono H, Ichikawa D. Is surgery the best treatment for elderly gastric cancer patients? World J Gastrointest Surg 2021; 13:1351-1360. [PMID: 34950425 PMCID: PMC8649569 DOI: 10.4240/wjgs.v13.i11.1351] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
As the elderly population increases, the number of patients with gastric cancer has also been increasing. Elderly people have various preoperative problems such as malnutrition, high frequency of comorbidities, decreased performance status, and dementia. Furthermore, when surgery is performed, high postoperative complication rates and death from other diseases are also concerns. The goal of surgery in the elderly is that short-term outcomes are comparable to those in nonelderly, and long-term outcomes reach life expectancy. Perioperative problems in the elderly include: (1) Poor perioperative nutritional status; (2) Postoperative pneumonia; and (3) Psychological problems (dementia and postoperative delirium). Malnutrition in the elderly has been reported to be associated with increased postoperative complications and dementia, pointing out the importance of nutritional management. In addition, multidisciplinary team efforts, including perioperative respiratory rehabilitation, preoperative oral care, and early postoperative mobilization programs, are effective in preventing postoperative pneumonia. Furthermore, there are many reports on the usefulness of laparoscopic surgery for the elderly, and we considered that minimally invasive surgery would be the optimal treatment after assessing preoperative risk.
Collapse
Affiliation(s)
- Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hidenori Akaike
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Katsutoshi Shoda
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Naohiro Hosomura
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hidetake Amemiya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hiromichi Kawaida
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hiroshi Kono
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| |
Collapse
|
|
10
|
Paredes-Torres OR, García-Ruiz L, Luna-Abanto J, Meza-García K, Chávez-Passiuri I, Berrospi-Espinoza F, Luque-Vásquez Vásquez C, Ruiz-Figueroa E, Payet-Meza E. Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:149-158. [PMID: 34362678 DOI: 10.1016/j.rgmxen.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. MATERIALS AND METHODS A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. RESULTS The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥70 years (OR = 1.85, 95% CI: 1.25-2.76), ASA III-IV (OR = 2.06, 95% CI: 1.28-3.34), total gastrectomy (OR = 1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR = 5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age ≥70 years (OR = 4.92, 95% CI:1.78-13.65), lower BMI (OR = 0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR = 0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. CONCLUSIONS D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age ≥70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age ≥70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.
Collapse
Affiliation(s)
- O R Paredes-Torres
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru.
| | - L García-Ruiz
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - J Luna-Abanto
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - K Meza-García
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - I Chávez-Passiuri
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - F Berrospi-Espinoza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - C Luque-Vásquez Vásquez
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - E Ruiz-Figueroa
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - E Payet-Meza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| |
Collapse
|
|
11
|
Paredes-Torres OR, García-Ruiz L, Luna-Abanto J, Meza-García K, Chávez-Passiuri I, Berrospi-Espinoza F, Luque-Vásquez Vásquez C, Ruiz-Figueroa E, Payet-Meza E. Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 87:S0375-0906(21)00013-6. [PMID: 33752940 DOI: 10.1016/j.rgmx.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/30/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND AIMS Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. MATERIALS AND METHODS A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. RESULTS The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥ 70 years (OR=1.85, 95% CI: 1.25-2.76), ASA III-IV (OR=2.06, 95% CI: 1.28-3.34), total gastrectomy (OR=1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR=5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age≥70 years (OR=4.92, 95% CI:1.78-13.65), lower BMI (OR=0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR=0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. CONCLUSIONS D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age≥70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age≥70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.
Collapse
Affiliation(s)
- O R Paredes-Torres
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú.
| | - L García-Ruiz
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - J Luna-Abanto
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - K Meza-García
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - I Chávez-Passiuri
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - F Berrospi-Espinoza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - C Luque-Vásquez Vásquez
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - E Ruiz-Figueroa
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - E Payet-Meza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| |
Collapse
|
|
12
|
Silva FDA, Pereira MA, Ramos MFKP, Ribeiro-Junior U, Zilberstein B, Cecconello I, Dias AR. GASTRECTOMY IN OCTOGENARIANS WITH GASTRIC CANCER: IS IT FEASIBLE? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 33:e1552. [PMID: 33503112 PMCID: PMC7836070 DOI: 10.1590/0102-672020200004e1552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/20/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The octogenarian population is expanding worldwide and demand for gastrectomy due to gastric cancer in this population is expected to grow. However, the outcomes of surgery with curative intent in this age group are poorly reported and it is unclear what matters most to survival: age, clinical status, disease´s stage, or the extent of the surgery performed. AIM Evaluate the results of gastrectomy in octogenarians with gastric cancer and to verify the factors related to survival. METHODS From prospective database, patients aged 80 years or older with histologically confirmed adenocarcinoma who had undergone gastrectomy with curative intent were selected. Factors related to postoperative complications and survival were studied. RESULTS Fifty-one patients fulfilled the inclusion criteria. A total of 70.5% received subtotal gastrectomy and in 72.5% D1 lymphadenectomy was performed. Twenty-five (49%) had complications, in eleven major complications occurred (seven of these were clinical complications). Hospital length of stay was longer (8.5 vs. 17.8 days, p=0.002), and overall survival shorter (median of 1.4 vs. 20.5 months, p=0.009) for those with complications. D2 lymphadenectomy and the presence of postoperative complications were independent factors for worse overall survival. CONCLUSION Octogenarians undergoing gastrectomy with curative intent have high risk for postoperative clinical complications. D1 lymphadenectomy should be the standard of care in these patients.
Collapse
Affiliation(s)
| | - Marina Alessandra Pereira
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, Cancer Institute, São Paulo, SP, Brazil
| | | | - Ulysses Ribeiro-Junior
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, Cancer Institute, São Paulo, SP, Brazil
| | - Bruno Zilberstein
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, Cancer Institute, São Paulo, SP, Brazil
| | - Ivan Cecconello
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, Cancer Institute, São Paulo, SP, Brazil
| | - Andre Roncon Dias
- Hospital de Clínicas, Faculty of Medicine, University of São Paulo, Cancer Institute, São Paulo, SP, Brazil
| |
Collapse
|
|
13
|
Zhu C, Wang X, Chen S, Yang X, Sun J, Pan B, Zhang W, Chen X, Huang Y. Efficacy of the Preoperative Albumin-Bilirubin Grade for Predicting Survival and Outcomes of Postoperative Chemotherapy for Advanced Gastric Cancer. Cancer Manag Res 2020; 12:11921-11932. [PMID: 33244269 PMCID: PMC7685381 DOI: 10.2147/cmar.s279782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/06/2020] [Indexed: 01/27/2023] Open
Abstract
Purpose The liver function index can predict the prognosis of hepatocellular carcinoma and many other non-neoplastic diseases. We aimed to determine whether the preoperative albumin–bilirubin (ALBI) grade could predict the prognosis of patients with gastric cancer (GC). Patients and Methods Data of 243 patients with GC who underwent radical resection were collected retrospectively. Patients were divided into the high ALBI (>−2.34) and low ALBI (≤−2.34) grade groups. Overall survival was analyzed between the two groups using the Kaplan–Meier curves. Univariate and multivariate analyses identified the independent factors associated with postoperative complications and overall survival. Results The postoperative complication rates were higher in the high ALBI grade group than in the low ALBI grade group (P=0.005). The high ALBI grade group also had worse overall survival (P<0.001), especially TNM stage II–III patients (stage II, P=0.043; stage III, P<0.001). In the high ALBI grade group, patients with TNM stage III not undergoing chemotherapy had significantly worse survival times (P=0.001). High ALBI grade (P=0.032), Charlson score of 1–2 (P=0.007), and laparotomy surgery (P=0.045) were independent risk factors for postoperative complications. High ALBI grade (P=0.005), age ≥70 years (P=0.002), nutritional risk screening score 2002 score of 5–6 (P=0.019), tumor located in the cardia (P=0.020), diffuse tumor (P<0.001), and TNM stage III (P<0.001) were independent risk factors for overall survival. Conclusion Preoperative ALBI grade could predict postoperative complications and overall survival of patients with GC, especially those with TNM stages II–III. This grading method has the advantages of preoperative availability, simplicity, and objectivity and aids in improving preoperative prognosis prediction and in achieving better outcomes of postoperative chemotherapy.
Collapse
Affiliation(s)
- Ce Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiang Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Sian Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xinxin Yang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jing Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Bujian Pan
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Weiteng Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yingpeng Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| |
Collapse
|
|
14
|
Bullock AF, Greenley SL, McKenzie GAG, Paton LW, Johnson MJ. Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis. Eur J Clin Nutr 2020; 74:1519-1535. [PMID: 32366995 PMCID: PMC7606134 DOI: 10.1038/s41430-020-0629-0] [Citation(s) in RCA: 175] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 12/25/2022]
Abstract
Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03-4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03-3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.
Collapse
Affiliation(s)
- Alex F Bullock
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
| | - Sarah L Greenley
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Gordon A G McKenzie
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lewis W Paton
- Department of Health Sciences, University of York, York, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
|
15
|
Hashimoto T, Kurokawa Y, Mikami J, Takahashi T, Miyazaki Y, Tanaka K, Makino T, Yamasaki M, Motoori M, Kimura Y, Nakajima K, Mori M, Doki Y. Postoperative Long-Term Outcomes in Elderly Patients with Gastric Cancer and Risk Factors for Death from Other Diseases. World J Surg 2020; 43:2885-2893. [PMID: 31388706 DOI: 10.1007/s00268-019-05109-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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.
Collapse
Affiliation(s)
- Tadayoshi Hashimoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Jota Mikami
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Kimura
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Mori
- Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
|
16
|
Liu X, Xue Z, Yu J, Li Z, Ma Z, Kang W, Ye X, Jiang L. Risk Factors for Postoperative Infectious Complications in Elderly Patients with Gastric Cancer. Cancer Manag Res 2020; 12:4391-4398. [PMID: 32606934 PMCID: PMC7293399 DOI: 10.2147/cmar.s253649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background Elderly patients with gastric cancer (GC) are at increased risk of infectious complications following gastrectomy. A limited set of risk factors has been identified to predict complications in these patients. To improve the safety of gastrectomy in this population, we investigated the incidence of infectious complications and associated clinicopathologic, nutritional and surgical risk factors in a cohort of elderly patients with GC. Methods Elderly GC patients (≥70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included in the study. Clinicopathologic data were collected retrospectively. Severity of complications was classified using the Clavien–Dindo system. Infectious complications were assessed based on clinical diagnosis of health care-associated infection as defined by the US Centers for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the risk factors for infectious complications. Results Three hundred thirty-one consecutive patients were included, with a median age of 74 years (range 70–88). The rate of surgical morbidity was 37.5% and the mortality rate was 1.2%. The incidence of infectious complications was 19.6%, with the most common infectious complication being pulmonary infection (11.5%). Preoperative weight loss ≥5% (odds ratio [OR] = 2.21; 95% CI, 1.15–4.28; p = 0.018), Charlson comorbidity index score ≥3 (OR = 2.83; 95% CI, 1.30–6.16; p = 0.009) and preoperative hsCRP level ≥10 mg/L (OR = 2.48; 95% CI, 1.14–5.38; p = 0.022) were independently associated with infectious complications. Conclusion Preoperative weight loss, elevated hsCRP level and comorbidity burden can be used to predict postoperative infectious complications in elderly GC patients. It is recommended to pay more attention to the treatment of elderly GC patients with these risk factors.
Collapse
Affiliation(s)
- Xiao Liu
- Department of Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| |
Collapse
|
|
17
|
Lopez-Lopez V, Gómez-Ruiz AJ, Eshmuminov D, Cascales-Campos PA, Alconchel F, Arevalo-Perez J, Robles Campos R, Parrilla Paricio P. Surgical oncology in patients aged 80 years and older is associated with increased postoperative morbidity and mortality: A systematic review and meta-analysis of literature over 25 years. Surg Oncol 2020; 33:81-95. [PMID: 32561103 DOI: 10.1016/j.suronc.2019.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The study aim is to analyze the evolution over the last 25 years of the results reported after abdominal oncological surgery in patients aged 80 years of age and older. The primary endpoint was morbidity and mortality in this group of patients; the secondary endpoint was overall survival. METHODS A systematic search strategy was used to browse through Medline/PubMed, EMBASE, Scopus, ClinicalTrials.gov, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials using a combination of standardized index terms. Studies published between 1997 and 2017 were selected. Only those studies that showed morbidity and mortality after digestive and hepatobiliary tract oncological surgery in individuals aged 80 years and older were included. The PROSPERO registration number is CRD42018087921. PRISMA and MOOSE guidelines were applied. RESULTS A total of 79 studies were included, categorized by origin of malignancy: esophageal (7), stomach (26), liver (4), pancreas (19), and colorectal (23). Compared with the non-elderly group, the elderly group had similar esophageal morbidity with higher mortality (RR 2.51, 1.50 to 4.21; P = 0.0005); higher gastric morbidity (RR 1.25, 1.09 to 1.43; P = 0.001), and mortality (RR 2.51, 1.81 to 3.49; P = 0.0001); similar liver morbidity and mortality; higher pancreatic morbidity (RR 1.17, 1.03 to 1.33; P = 0.02) and mortality (RR 2.37, 1.86 to 3.03; P < 0.00001); and similar colorectal morbidity with higher mortality (RR 4.44, 1.91 to 10.32; P = 0.005). CONCLUSION Oncological surgery of most abdominal visceral tumors is associated with increased morbidity and mortality in patients older than 80 years.
Collapse
Affiliation(s)
- V Lopez-Lopez
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - A J Gómez-Ruiz
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain.
| | - D Eshmuminov
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland
| | | | - F Alconchel
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - J Arevalo-Perez
- Memorial Sloan Kettering Cancer Center. Radiology Departament, New York, USA
| | - R Robles Campos
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - P Parrilla Paricio
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| |
Collapse
|
|
18
|
Guo J, Yu J, Xu Z, Sun X, Zheng J. The role of surgery in patients aged 85 years or older with resectable gastric cancer: a propensity score matching analysis of the SEER database. Scand J Gastroenterol 2020; 55:694-700. [PMID: 32459113 DOI: 10.1080/00365521.2020.1769175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: An increasing number of newly diagnosed resectable gastric cancer (GC) patients are over 85 years of age. However, studies on surgical treatment in these patients are limited. This study aimed to explore the prognosis of a large sample of the oldest old GC patients receiving surgery.Methods: A total of 2914 oldest old patients with stage I-III GC were included in the linked Surveillance, Epidemiology, and End Results (SEER) database from 2006 to 2015. Based on their treatment, we assigned these patients to the surgery and no surgery groups. We used propensity score matching (1:1) to balance the baseline characteristics. The Kaplan-Meier method was used for the survival analysis. Multivariate Cox regression analysis was used to analyse the independent risk factors.Results: After propensity score matching, the median overall survival (OS) times in the surgery and no surgery groups were 24.0 (95% CI: 20.3-27.7) and 4.0 (95% CI: 3.5-4.5) months, respectively (p < .01). Age, sex, stage, histological type, and treatment with surgery and chemotherapy were independent risk factors for OS in the oldest old patients with GC. In total, 19% of the oldest old patients with GC died from causes unrelated to cancer.Conclusions: The current large-scale study demonstrated that the oldest old patients with stage I-III GC could benefit from elective surgery.
Collapse
Affiliation(s)
- Jing Guo
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junhui Yu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhengshui Xu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuejun Sun
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianbao Zheng
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
|
19
|
Sugawara K, Yamashita H, Urabe M, Okumura Y, Yagi K, Aikou S, Seto Y. Poor nutritional status and sarcopenia influences survival outcomes in gastric carcinoma patients undergoing radical surgery. Eur J Surg Oncol 2020; 46:1963-1970. [PMID: 32402508 DOI: 10.1016/j.ejso.2020.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/18/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The survival impacts of the prognostic nutritional index (PNI) and sarcopenia have been separately investigated in patients with gastric carcinoma (GC), while the prognostic impact of the combination of them remains to be addressed. METHODS In total, 1166 GC patients undergoing radical gastrectomy were retrospectively reviewed. A new prognostic score (PNIS) was developed based on preoperative PNI and sarcopenia; patients with both low PNI (≤44.8) and sarcopenia were allocated a score of 2, and those with only one or neither of these abnormalities were assigned a score of 1 or 0, respectively. RESULTS A lower PNI was independently associated with sarcopenia (P = 0.007). There were 704 (60.4%), 356 (30.5%) and 106 (9.1%) patients in the PNIS 0, 1 and 2 groups, respectively. A higher PNIS was associated with advanced age (P < 0.001) and a higher incidence of postoperative complications (P = 0.01). Patients with PNIS 2 showed significantly poorer overall survival (OS) than those with PNIS 1 or 0 (5-year OS; 57.8% vs. 79.2% vs. 91.6%, P < 0.001). Multivariate Cox hazards analysis showed PNIS 2 to be a powerful predictor of poor OS (HR 5.73, P < 0.001) in patients with pStage I disease, while not being independently associated with OS in those with pStage II/III disease. Patients with PNIS 2 had a markedly higher prevalence of non-GC-related death than those with scores of 0-1. CONCLUSION The scoring system combining PNI and sarcopenia is useful for predicting survival outcomes, especially non-GC-related death, in patients with early GC, a population with basically good oncological outcomes.
Collapse
Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Urabe
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Bariatric & Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
|
20
|
Shoka M, Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K, Murai T, Asada T, Ishiyama A, Matsushita H, Tanaka C, Kobayashi D, Fujiwara M, Murotani K, Kodera Y. Systemic Inflammation Score as a Predictor of Pneumonia after Radical Resection of Gastric Cancer: Analysis of a Multi-Institutional Dataset. Dig Surg 2020; 37:401-410. [PMID: 32344400 DOI: 10.1159/000506940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Curative treatment for gastric cancer (GC) comprising gastrectomy with systematic lymph node dissection can result in postoperative complications. Postoperative pneumonia is sometimes fatal, like surgery-related complications such as anastomotic leakage. In this retrospective study, we analyzed a multi-institutional collaborative dataset with the aim of identifying predictors of postgastrectomy pneumonia. METHODS From a retrospective database of 3,484 patients who had undergone gastrectomy for GC at nine Japanese institutions between 2010 and 2014, 1,415 patients who met all eligibility criteria were identified as eligible for analysis. Predictive values of 31 candidate variables for postoperative pneumonia were assessed. RESULTS Forty-two patients (3.0%) had grade II or higher postoperative pneumonia. Preoperative systemic inflammation score (SIS) had the greatest area under the curve (0.655) for predicting postoperative pneumonia (optimal cutoff value = 2). The odds ratio (OR) of high SISs associated with postoperative pneumonia was 3.10 (95% confidence interval [CI], 1.54-6.07; p < 0.001). Multivariate binomial logistic analysis identified high SIS as an independent risk factor for postoperative pneumonia (OR, 2.31; 95% CI, 1.19-4.48; p = 0.013). A forest plot revealed that ORs of high SISs were highest in female patients. CONCLUSIONS Our findings indicate that the preoperative SIS may serve as a simple predictor of postgastrectomy pneumonia, assisting physicians' efforts to take preventive measures against this complication.
Collapse
Affiliation(s)
- Michita Shoka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan,
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan
| | | | - Hitoshi Teramoto
- Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | | | - Toshifumi Murai
- Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takahiro Asada
- Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | | | | | - Chie Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Kobayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
|
21
|
Sugawara K, Aikou S, Yajima S, Uemura Y, Okumura Y, Nishida M, Yagi K, Yamashita H, Seto Y. Pre- and post-operative low prognostic nutritional index influences survival in older patients with gastric carcinoma. J Geriatr Oncol 2020; 11:989-996. [PMID: 32146093 DOI: 10.1016/j.jgo.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/21/2019] [Accepted: 02/19/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The survival impact of the preoperative prognostic nutritional index (PNI) has been investigated in older patients with gastric carcinoma (GC), while that of the postoperative PNI has yet to be addressed. We evaluated the significance of PNI before and after surgery in older GC patients (≥75 years). MATERIALS AND METHODS In total, 309 older GC patients undergoing radical gastrectomy between 2006 and 2016 were retrospectively reviewed. The PNI was evaluated before and at six months after gastrectomy. Patients were divided into low (<45) and high (≥45) PNI groups. The impact of low PNI on overall survival (OS), cancer-specific survival (CSS), and non-GC-related death were investigated. RESULTS Low PNI was present in 134 patients (43.4%) preoperatively and 121 (39.2%) postoperatively. Low pre-PNI was independently associated with poor overall survival (P < .001). Similarly, OS was significantly stratified by post-PNI (P < .001). The significant survival difference according to post-PNI was present only in pStage I disease (P < .001). Low post-PNI independently increased the risk of non-GC-related death in a multivariable analysis (P = .002). In contrast, CSS was not stratified by post-PNI (P = .45). In the high pre-PNI group, total gastrectomy and super-older age (≥80 years) independently increased the risk of low post-PNI, which was significantly associated with poor survival outcomes. CONCLUSIONS Pre- and post-operative PNI are useful for predicting long-term outcomes in older patients with GC. Low postoperative PNI is a powerful determinant of mortality due to other diseases. Optimal perioperative management is required for those at high risk of malnutrition postoperatively.
Collapse
Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan; Department of Bariatric & Metabolic Care, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Sho Yajima
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Masato Nishida
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| |
Collapse
|
|
22
|
Preoperative restrictive pulmonary dysfunction influences the survival after gastrectomy for elderly patients with gastric carcinoma. Surg Today 2020; 50:1065-1073. [DOI: 10.1007/s00595-020-01983-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/11/2020] [Indexed: 12/14/2022]
|
|
23
|
Chen E, Senders ZJ, Hardacre J, Kim J, Ammori J. Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric adenocarcinoma. J Surg Oncol 2020; 121:1015-1021. [PMID: 32090338 DOI: 10.1002/jso.25866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current data are conflicting as to whether the outcomes of octogenarians undergoing resection for esophagogastric adenocarcinoma are comparable to younger patients. This study aims to compare perioperative outcomes and survival of patients ≥80 years old with younger patients undergoing curative resection for esophagogastric adenocarcinoma. METHODS Retrospective data were collected on 190 patients who underwent resection with curative intent for adenocarcinomas found in the stomach and esophagogastric junction from 2004 to 2015 at a single institution. RESULTS Of the 190 patients, 34 (18%) were ≥80 years old. Octogenarians were more likely to have chronic kidney disease (CKD) and were less likely to have received neoadjuvant chemotherapy. Pathologic features were similar between groups. Octogenarians' tumors were more likely to be located in the gastric body as compared to the esophagogastric junction in younger patients. Although the length of stay was comparable, octogenarians were significantly less likely to be discharged home (P < .01). Both groups had a single death during the index admission. Incidence and severity of 90 days postoperative complications were not significantly different between groups. There was no difference in 30-day, 90-day, 1-year, or median survival. CONCLUSIONS Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric cancer are comparable to younger patients at our institution.
Collapse
Affiliation(s)
- Eric Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Zachary J Senders
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey Hardacre
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Julian Kim
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - John Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
|
24
|
Wong JU, Tai FC, Huang CC. An examination of surgical and survival outcomes in the elderly (65-79 years of age) and the very elderly (≥80 years of age) who received surgery for gastric cancer. Curr Med Res Opin 2020; 36:229-233. [PMID: 31841040 DOI: 10.1080/03007995.2018.1520083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: The purpose of this study was to examine surgical and survival outcomes in the elderly (65-79 years of age) and the very elderly (≥80 years of age) who received surgery for gastric cancer.Methods: This study retrospectively reviewed the records of patients ≥65 years old who received a gastrectomy for gastric adenocarcinoma. Demographic, clinical, and pathological data were extracted from the medical records. Patients were divided into two groups: those 65-79 years of age and those ≥80 years of age. Data and survival outcomes were compared between the groups.Results: Sixty-four patients were included, 32 males and 32 females. The mean age in the 65-79 years old group was 73.4 ± 4.5 years, and in the ≥80 years group was 85.2 ± 3.4 years (p < .001). Three patients in the older group had chronic kidney disease, as compared to none in the 65-79 years group (p = .04); all other demographic, clinical, tumor, and surgical characteristics were similar between the groups, except for surgical time (all, p > .05). Patients ≥80 years had a higher incidence of pulmonary complications (24% vs 4.7%, p = .03), but there was no significant difference in in-hospital mortality. The ≥80 years group had a higher overall survival, but the difference between the groups was not statistically significant (42.9% and 34.9%, p = .224).Conclusions: Curative intent resection, gastrectomy with D1+/D2 lymph node dissection is a viable option for elders ≥80 years old with gastric carcinoma.
Collapse
Affiliation(s)
- Jia-Uei Wong
- Division of General Surgery, Department of Surgery, Cathay General Hospital, New Taipei City, Taiwan, China
- Division of General Surgery, Department of Surgery, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan China
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, China
| | - Feng-Chuan Tai
- Division of General Surgery, Department of Surgery, Cathay General Hospital, New Taipei City, Taiwan, China
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, China
| | - Chi-Cheng Huang
- Division of General Surgery, Department of Surgery, Cathay General Hospital, New Taipei City, Taiwan, China
- Division of General Surgery, Department of Surgery, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan China
- School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, China
| |
Collapse
|
|
25
|
Abe A, Kurita K, Hayashi H, Ishihama T, Ueda A. Correlation between prognostic nutritional index and occlusal status in gastric cancer. Oral Dis 2019; 26:465-472. [PMID: 31758866 DOI: 10.1111/odi.13242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/15/2019] [Accepted: 10/30/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Systemic inflammatory responses in cancer patients are important factors for nutrition and prognosis. This study evaluates the association between tooth loss, occlusal status, and prognostic nutritional index (PNI). METHODS A total of 93 patients with gastric cancer were included. These parameters were investigated the following: stage, body mass index (BMI), total lymphocyte count, C-reactive protein (CRP), PNI, and albumin (ALB). Patients were divided into three groups by Eichner classification (group A had contact in four support zones; group B had in one to three zones or in anterior region; and group C had no contact). PNI assumed 40 or less undernutrition. Multiple regression analysis was performed (PNI, dependent variable; Eichner index, main independent variable), using four independent variables (sex, age, BMI, and CRP) as adjustment factors. RESULTS The mean ± SD PNI in groups A, B, and C was 43.0 ± 4.7, 41.7 ± 5.2, and 36.7 ± 7.7, respectively. A significant positive correlation was found between the number of teeth, both ALB, and PNI. ALB and PNI differed significantly between groups A and C (ALB, p = .0003; PNI, p = .005). CONCLUSION We recommend a preoperative dental evaluation for assessing the nutritional status of patients with gastric cancer.
Collapse
Affiliation(s)
- Atsushi Abe
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Kenichi Kurita
- Department of Oral and Maxillofacial Surgery, Aichi-Gakuin University, Nagoya, Japan
| | - Hiroki Hayashi
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Takanori Ishihama
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Akane Ueda
- Department of Oral and Maxillofacial Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| |
Collapse
|
|
26
|
Shibata C, Ogawa H, Nakano T, Koyama K, Yamamoto K, Nagao M, Takeyama D, Takami K, Yasumoto A, Sase T, Kimura SI, Sawada K, Katayose Y. Influence of age on postoperative complications especially pneumonia after gastrectomy for gastric cancer. BMC Surg 2019; 19:106. [PMID: 31395044 PMCID: PMC6686256 DOI: 10.1186/s12893-019-0573-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/01/2019] [Indexed: 12/19/2022] Open
Abstract
Background The aim of this study was to investigate the influence of patients’ age on postoperative morbidities including pneumonia. Methods We reviewed the clinical records of 211 patients with stages I – III gastric cancer undergoing curative distal gastrectomy (DG) or total gastrectomy (TG). Patients were classified into an elderly (≧80 y.o.) or a control (< 80 y.o.) group. We compared patient characteristics (sex ratio, disease stage, degree of lymph node dissection, number of retrieved lymph nodes, and type of reconstruction) and early postoperative outcomes (operation time, intra-operative blood loss, and postoperative morbidity including pneumonia, and mortality) between the two groups separately in DG and TG. Results There were 134 and 77 patients who underwent DG and TG, respectively. The numbers of patients in the elderly and control groups were 25 and 109 in DG and 12 and 65 in TG. The percentage of female patients in the elderly group was greater than that in the control group in both DG and TG. The extent of lymph node dissection did not differ between two groups in TG; in contrast in DG, the rate of a D1 dissection was greater in the elderly group than in the control group. There were no differences between the two groups in distribution of disease stage, number of retrieved lymph nodes, operation time, and blood loss in DG and in TG. Overall postoperative morbidity did not differ between two groups after DG and after TG. The rate of infectious complications in the elderly group was not different from that in the control group after DG and after TG. The incidence of pneumonia was more frequent in the elderly group compared to the control group after DG (8% vs. 1%, P < 0.05) but not after TG (17% vs. 5%). When patients were compared between the elderly and the control groups regardless of type of gastrectomy, the incidence of pneumonia in the elderly group (4/37 (11%)) was greater than that in the control group (4/174 (2%), P < 0.05). Conclusions These results suggest that pneumonia is increased in patients older than 80 years after DG.
Collapse
Affiliation(s)
- Chikashi Shibata
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan.
| | - Hitoshi Ogawa
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Toru Nakano
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Kaori Koyama
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Kuniharu Yamamoto
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Munenori Nagao
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Daisuke Takeyama
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Kazuhiro Takami
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Akihiro Yasumoto
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Tomohiko Sase
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Shun-Ichi Kimura
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Kentaro Sawada
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| | - Yu Katayose
- Division of Gastroenterologic and Hepato-biliary-pancreatic Surgery, Department of Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, 983-8512, Japan
| |
Collapse
|
|
27
|
Xu Y, Wang Y, Xi C, Ye N, Xu X. Is it safe to perform gastrectomy in gastric cancer patients aged 80 or older?: A meta-analysis and systematic review. Medicine (Baltimore) 2019; 98:e16092. [PMID: 31192972 PMCID: PMC6587649 DOI: 10.1097/md.0000000000016092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Few studies have focused on octogenarian patients with gastric cancer (GC) who have undergone gastrectomy. This meta-analysis of published studies was performed to assess the safety of treating octogenarian GC patients with surgery. METHODS Databases, including PubMed, Embase, Web of Science, and Cochrane Library were searched until January 2019. The incidence of preoperative comorbidities, postoperative complications, and mortality was assessed using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Further, the hazard ratios (HRs) with 95% CIs were applied for survival outcomes. RESULTS A total of 18,179 patients with GC in 21 studies were included. Our results demonstrated that octogenarian patients were associated with a higher burden of comorbidities (OR = 2.79; 95% CI: 2.37, 3.28; P = .00), high incidences of overall postoperative complications (OR = 1.48; 95% CI: 1.22, 1.81; P = .00), medical postoperative complications (OR = 2.58; 95% CI: 1.91, 3.49; P = .00), in-hospital mortality (OR = 3.24; 95% CI: 2.43, 4.31; P = .00) and poor overall survival (HR = 1.96; 95% CI: 1.65, 2.27; P = .00). CONCLUSIONS Considering the high burden of comorbidities, high incidences of postoperative complications and mortality, surgery for extremely elderly patients with GC requires deliberation. Individualized treatment is recommended for such patients.
Collapse
|
|
28
|
Li Z, Zhao Y, Liu Y, Yu D, Zhao Q. Laparoscopic versus open gastrectomy for high-risk patients with gastric cancer: A systematic review and meta-analysis. Int J Surg 2019; 65:52-60. [PMID: 30867126 DOI: 10.1016/j.ijsu.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/08/2019] [Accepted: 03/01/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND It is still remains unclear whether high-risk patients with gastric cancer can benefit from the application of laparoscopic gastrectomy (LG). The aim of this systematic review was to evaluate the surgical and long-term outcomes after LG and open gastrectomy (OG) for high-risk patients with gastric cancer. METHODS We performed a systematic literature search in various databases from January 1994 to June 2018. Patients who had≥1 of the following conditions were defined as high-risk patients: (1) age≥70 years; (2) BMI≥30 kg/m2; (3) ASA (American Society of Anesthesiologists) grade≥3; or (4) clinical T4 stage (cT4). The results were analyzed according to predefined criteria. RESULTS In the present meta-analysis, the outcomes of 12 non-randomized controlled studies enrolling 1651 patients (873 in the LG group and 778 in the OG group) were pooled. The estimated blood loss was significantly lower in the LG group than those in the OG group (P < 0.01). There was no significant difference between two groups in operative time (P = 0.17) and number of harvested lymph nodes (P = 0.21). In the LG group, the time to flatus (P < 0.01), time to food intake (P < 0.01), and postoperative hospital stay (P < 0.01) were significantly shorter than those in the OG group. A lower overall postoperative complication rate was observed in the LG group (P < 0.01). The incidence of surgical (P < 0.01) and non-surgical (P < 0.01) complication was significantly lower in the LG group than that in the OG group. The pooled analysis showed no significant difference in overall survival (OS) between LG and OG groups (P = 0.98). CONCLUSIONS LG can be a safe and feasible procedure for high-risk patients with gastric cancer.
Collapse
Affiliation(s)
- Zhengyan Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
| | - Yan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Yezhou Liu
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Deliang Yu
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Qingchuan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
| |
Collapse
|
|
29
|
Ramos MFKP, Pereira MA, Dias AR, Yagi OK, Zaidan EP, Ribeiro-Júnior U, Zilberstein B, Cecconello I. Surgical outcomes of gastrectomy with D1 lymph node dissection performed for patients with unfavorable clinical conditions. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:460-465. [PMID: 30497814 DOI: 10.1016/j.ejso.2018.11.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 10/16/2018] [Accepted: 11/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric cancer (GC) patients with advanced age and/or multiple morbidities have limited expected survival and may not benefit from extended lymph node resection. The aim of this study was to evaluate the surgical outcomes of these GC patients who underwent gastrectomy with D1 dissection. METHODS We retrospectively reviewed all GC patients who underwent gastrectomy with curative intent from 2009 to 2017. The decision to perform D1 was based on preoperative multidisciplinary meeting, and/or intraoperative clinical judgment. RESULTS Among 460 enrolled patients, 73 (15.9%) underwent D1 lymphadenectomy and 387 (84.1%) D2 lymphadenectomy. Male gender, older age, American Society of Anesthesiologists score (ASA) III/IV, higher neutrophil-to-lymphocyte ratio (NLR) and higher Charlson Comorbidity Index (CCI) were more common in the D1 group. Postoperative major complications were significantly higher in D1 group (24.7% vs 12.4%, p < 0.001) and mostly related to clinical complications. Locoregional recurrence was higher in the D1 group (53.8% vs 39.5%, p = 0.330) however, without statistical significance. No difference was found in disease-free survival (DFS) between D1 and D2 patients with positive lymph nodes (p = 0.192), whereas overall survival was longer in the D2 group (p < 0.001). Multivariate analysis showed a statistically significant impact on survival of age ≥70 years, CCI ≥5, total gastrectomy, D1 lymphadenectomy and advanced stages (III/IV). CONCLUSIONS Frail patients had high surgical mortality even when submitted to D1 dissection. DFS was comparable to D2. Extent of lymphadenectomy in high-risk patients should take in account the expectation of a decrease in surgical risk with the possibility of impairment of long-term survival.
Collapse
Affiliation(s)
| | | | - Andre Roncon Dias
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Osmar Kenji Yagi
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Ulysses Ribeiro-Júnior
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruno Zilberstein
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Ivan Cecconello
- Cancer Institute, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| |
Collapse
|
|
30
|
Lin J, Zhang W, Huang Y, Chen W, Wu R, Chen X, Lou N, Wang P. Sarcopenia is associated with the neutrophil/lymphocyte and platelet/lymphocyte ratios in operable gastric cancer patients: a prospective study. Cancer Manag Res 2018; 10:4935-4944. [PMID: 30464594 PMCID: PMC6208548 DOI: 10.2147/cmar.s175421] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Sarcopenia is distinguished by decreased skeletal muscle plus low muscle strength and/or physical performance. This study was designed to demonstrate the relationship between sarcopenia and systemic inflammatory response (neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio [PLR], and large platelet/lymphocyte ratio [LPLR]) prior to radical gastrectomy for gastric cancer. Patients and methods We conducted a prospective study of gastric cancer patients who underwent radical gastrectomy. The clinical utility of the NLR, PLR, and LPLR was evaluated by receiver operating characteristic curves. Sarcopenia components including skeletal muscle index, handgrip strength, and 6 m usual gait speed were measured. Logistic analysis was used to identify the independent indices associated with sarcopenia. Results A total of 670 patients were included, representing 504 men and 166 women. Of these, 104 patients (15.5%) were diagnosed with sarcopenia and 567 (84.5%) were non-sarcopenia. PLR has a diagnostic sensitivity of 91.3% for sarcopenia. In addition to the indicators of preoperative age, nutritional risk screening, body mass index, preoperative albumin, and diabetes, the NLR and PLR were independent predictors for sarcopenia (P<0.05). Conclusion The present study showed that at-diagnosis sarcopenia was associated with inflammation in patients with operable gastric cancer. Due to the complex assessment of muscle condition, PLR may be used as a primary screening test for sarcopenia. How systemic inflammatory response influences changes in sarcopenia may provide new therapeutic perception toward improving outcomes.
Collapse
Affiliation(s)
- Ji Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Weiteng Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Yunshi Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Weisheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Ruisen Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Neng Lou
- Department of General Surgery, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, China,
| | - Pengfei Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| |
Collapse
|
|
31
|
Zhao G, Cao XL, Yu T, An Q, Yang H, Xiao G. Treatment selection for gastric cancer in extremely elderly patients. Chin Med J (Engl) 2018; 131:2122-2124. [PMID: 30127226 PMCID: PMC6111689 DOI: 10.4103/0366-6999.239313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gang Zhao
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Xiang-Long Cao
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Tao Yu
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qi An
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Hua Yang
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Gang Xiao
- Department of Gastrointestinal Surgery, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| |
Collapse
|
|
32
|
Mengardo V, Cormack OM, Weindelmayer J, Chaudry A, Bencivenga M, Giacopuzzi S, Allum WH, de Manzoni G. Multicenter Study of Presentation, Management, and Postoperative and Long-Term Outcomes of Septegenerians and Octogenerians Undergoing Gastrectomy for Gastric Cancer. Ann Surg Oncol 2018; 25:2374-2382. [PMID: 29868974 DOI: 10.1245/s10434-018-6543-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The optimal treatment strategy for elderly patients with gastric cancer is still controversial. This study aimed to assess the impact of age on short- and long-term outcomes after treatment for primary gastric cancer. METHODS From January 2004 to December 2014, a total of 507 patients underwent gastrectomy for gastric adenocarcinoma at two high-volume upper gastrointestinal (GI) centers. The patients were classified into three groups as follows: group A (patients ≤ 69 years old, n = 266), group B (patients 70-79 years old, n = 166), and group C (patients ≥ 80 years old, n = 75). Clinicopathologic characteristics as well as, short- and long-term outcomes were compared between the groups. RESULTS The patients in groups B and C had more comorbidities, whereas the younger subjects (group A) had more advanced tumor stages. Less extensive surgery was performed in the groups B and C. Older patients (age ≥ 70 years) had more postoperative medical complications. Moreover, group C had a higher postoperative mortality rate (8.1%) than group A (1.8%) or group B (1.9%). In the multivariable analysis, age older than 80 years (group C) was a negative independent factor for overall survival (OS) (hazard ratio [HR], 2.36) compared with group A, whereas group B seemed to have a comparable risk (HR, 1.37). Notably, the three groups did not show significant differences in disease-related survival (DRS). CONCLUSION The data suggest that patients 70-79 years of age show a risk of postoperative death comparable with that of younger subjects. However, patients older than 80 years should be carefully selected for surgical treatment due to the increased risk of postoperative mortality.
Collapse
Affiliation(s)
- Valentina Mengardo
- General and Upper GI Surgery Division, University of Verona, Verona, Italy.
| | - Orla Mc Cormack
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | | | - Asif Chaudry
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - Maria Bencivenga
- General and Upper GI Surgery Division, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University of Verona, Verona, Italy
| | - William H Allum
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | | |
Collapse
|
|
33
|
Underutilization of Treatment for Regional Gastric Cancer Among the Elderly in the USA. J Gastrointest Surg 2018; 22:955-963. [PMID: 29404983 PMCID: PMC5983904 DOI: 10.1007/s11605-018-3691-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/09/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the USA, a quarter of elderly patients do not receive any treatment for regional gastric cancer, which results in poorer outcomes. We sought to identify factors associated with undertreatment of regional gastric cancer in this population, as well as to assess overall survival in the undertreated population. METHODS Elderly patients (aged ≥ 65 years) diagnosed with regional gastric cancer between 2001 and 2009 were identified from the Surveillance Epidemiology and End Results (SEER)-Medicare linked databases. Treatment was defined as receiving any medical or surgical therapy for gastric cancer. Logistic regression analysis was used to identify factors associated with failure to receive treatment. Overall survival was analyzed using the Kaplan-Meier method and Cox proportional hazard model. RESULTS Of 5972 patients with regional gastric cancer, 1586 (26.5%) received no treatment. Median age was 78 years; 56.1% of patients were men. On multivariable analysis, the factors strongly associated with lack of therapy were age ≥ 80 years, black race, lower education level, and diagnosis before 2007. As expected, patients who received therapy had better overall survival (log-rank test, p < 0.001). Specifically, median survival and 5-year survival were 16.5 months and 20.5% for treated patients, compared with 9.1 months and 19.0% for untreated patients. CONCLUSIONS Elderly patients with gastric cancer have better overall 5-year survival after receiving treatment for their cancer. Disparities in the use of treatment for curable cancers are associated with older age, black race, lower educational level, and diagnosis before 2007.
Collapse
|
|
34
|
Nelen SD, Bosscha K, Lemmens VEPP, Hartgrink HH, Verhoeven RHA, de Wilt JHW. Morbidity and mortality according to age following gastrectomy for gastric cancer. Br J Surg 2018; 105:1163-1170. [PMID: 29683186 DOI: 10.1002/bjs.10836] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/13/2017] [Accepted: 01/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study investigated age-related differences in surgically treated patients with gastric cancer, and aimed to identify factors associated with outcome. METHODS Data from the Dutch Upper Gastrointestinal Cancer Audit were used. All patients with non-cardia gastric cancer registered between 2011 and 2015 who underwent surgery were selected. Patients were analysed by age group (less than 70 years versus 70 years or more). Multivariable logistic regression was used to assess the influence of clinicopathological factors on morbidity and mortality. RESULTS A total of 1109 patients younger than 70 years and 1206 aged 70 years or more were included. Patients aged at least 70 years had more perioperative or postoperative complications (41·2 versus 32·5 per cent; P < 0·001) and a higher 30-day mortality rate (7·9 versus 3·2 per cent; P < 0·001) than those younger than 70 years. In multivariable analysis, age 70 years or more was associated with a higher risk of complications (odds ratio 1·29, 95 per cent c.i. 1·05 to 1·59). Postoperative mortality was not significantly associated with age. In the entire cohort, morbidity and mortality were influenced most by ASA grade, neoadjuvant chemotherapy and type of resection. CONCLUSION ASA grade, neoadjuvant chemotherapy and type of resection are independent predictors of morbidity and death in patients with gastric cancer, irrespective of age.
Collapse
Affiliation(s)
- S D Nelen
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - V E P P Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
|
35
|
Hikage M, Tokunaga M, Makuuchi R, Irino T, Tanizawa Y, Bando E, Kawamura T, Terashima M. Surgical outcomes after gastrectomy in very elderly patients with gastric cancer. Surg Today 2018. [PMID: 29536199 DOI: 10.1007/s00595-018-1651-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Whether or not gastrectomy is feasible for very elderly gastric cancer patients is unclear. This study aimed to clarify the feasibility and safety of surgical treatment for patients in this age group. METHOD The study included 55 very elderly patients with resectable gastric cancer who underwent gastrectomy (≥ 85 years of age; very-E group). The surgical outcomes were compared with those of 611 elderly patients (75-84 years old; E group). RESULTS Female sex, a poor physical and performance status, and a low serum albumin level patients were more frequent in the very-E group than in the E group. Lymphadenectomy was less aggressive in the very-E group than in the E group (P < 0.001). The overall postoperative complication rate was not significantly different between the groups (46 vs 33%; P = 0.073). A multivariate analysis to predict the overall survival identified male sex (hazard ratio 1.75, 95% confidence interval 1.30-2.36), low body mass index (2.19, 1.52-3.16), poor performance status (2.14, 1.60-2.86), low serum albumin level (1.84, 1.37-2.48), and advanced tumor stage (1.71, 1.29-2.27) but not age (1.31, 0.84-2.03) as independent prognostic factors. CONCLUSION Chronological age alone is not a contraindicative factor for gastrectomy in very elderly patients.
Collapse
Affiliation(s)
- Makoto Hikage
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.,Department of Surgery, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Masanori Tokunaga
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan. .,Gastric Surgery Division, National Cancer Center East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomoyuki Irino
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Taiichi Kawamura
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | | |
Collapse
|
|
36
|
Characteristics of advanced gastric cancer with negative or only perigastric lymph node metastasis in elderly patients. Aging Clin Exp Res 2018; 30:161-168. [PMID: 28455621 DOI: 10.1007/s40520-017-0767-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/22/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES After gastrectomy with extended lymph node (LN) dissection, the damage of celiac plexus seems to cause of disorder of eating habits. To clarify the indication of gastrectomy with limited LN dissection for elderly patients, the pathological characteristics of advanced gastric cancer in elderly patients were examined in this study. METHODS Forty-seven patients aged ≥80 years with advanced gastric cancer (deeper than pT2) who underwent curative gastrectomy from 1998 to 2015 were enrolled. Patients were classified into two groups by extent of LN metastasis: Group A, with N0 or only perigastric LN metastasis (n = 33); Group B, LN metastasis beyond the perigastric area (n = 14). Pathological factors were then evaluated. RESULTS No significant differences were observed in age, sex, body mass index, American Society of Anesthesiologists physical status classification, serum level of carcinoembryonic antigen, surgical procedure, extent of LN dissection, and number of dissected LNs. Pathological findings showed no significant differences in tumor location, macroscopic type, histologic type, and lymphovascular invasion. However, significant differences were observed in tumor maximum diameter at the cut-off level of 40 mm (Group A: ≤40 mm, n = 10 and >40 mm, n = 23; Group B: ≤40 mm, n = 0 and >40 mm, n = 14; P = 0.02). CONCLUSION In the elderly patients, LN metastasis in advanced gastric cancer of ≤40 mm in diameter was limited to be within the perigastric area. Gastrectomy with only perigastric LN dissection may be adopted in these patients.
Collapse
|
|
37
|
Clinical impact of small advanced gastric cancer (≤ 40 mm) in elderly patients: A retrospective cohort study. Int J Surg 2017; 45:131-137. [DOI: 10.1016/j.ijsu.2017.07.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/06/2017] [Accepted: 07/14/2017] [Indexed: 01/07/2023]
|
|
38
|
Endo S, Shimizu Y, Ikenaga M, Ohta K, Yamada T. Survival benefit of gastrectomy for gastric cancer in patients ≥85 years old: A retrospective propensity score-matched analysis. Surgery 2017; 161:984-994. [PMID: 27894711 DOI: 10.1016/j.surg.2016.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The purpose of this study was to compare the long-term outcomes of patients ≥85 years old with gastric cancer who underwent curative distal gastrectomy or best supportive care alone. METHODS Among 241 consecutive patients aged ≥85 years who were diagnosed with gastric cancer, we retrospectively examined the cases of 56 patients that were treated with curative distal gastrectomy and 55 patients that were treated with best supportive care alone. To reduce selection bias, we conducted a propensity score-matching analysis. The patients' propensity scores were estimated using a logistic regression model based on the following variables: sex, age, clinical cancer stage, performance status score, and each item of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score. Overall survival was compared using the Kaplan-Meier method and log-rank test. RESULTS Thirty pairs of patients were generated via propensity score matching. The clinical characteristics of the 2 groups were well matched. The median overall survival time was 57.3 months after distal gastrectomy, while it was 16.0 months after best supportive care (P = .0002). Subgroup analyses of each sex showed that in males there was no significant difference in overall survival between distal gastrectomy and best supportive care (P = .37) while the overall survival of females was significantly better after distal gastrectomy than after best supportive care (P < .0001). CONCLUSION Our propensity score-matched study suggested that distal gastrectomy results in significantly better long-term survival than best supportive care alone in female patients with gastric cancer aged ≥85 years. In males, the indications for operation should be carefully determined.
Collapse
Affiliation(s)
- Shunji Endo
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan.
| | - Yosuke Shimizu
- Department of Surgery, National Hospital Organization Kure Medical Center/Chugoku Cancer Center, Kure, Japan
| | - Masakazu Ikenaga
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Katsuya Ohta
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Terumasa Yamada
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| |
Collapse
|
|
39
|
Lyadov VK, Kozyrin IA, Kovalenko ZA. [Radical oncological stomach, liver and pancreatic surgery in patients over 80 years old]. Khirurgiia (Mosk) 2017:54-58. [PMID: 28303874 DOI: 10.17116/hirurgia2017254-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze the results of radical surgery for upper GI cancer in patients ≥80 years old. MATERIAL AND METHODS For the period November 2010 - June 2015 there were 14 radical operations in elderly (≥80 years) patients with gastric, liver and pancreatic tumors. There were 4 Whipple procedures, 4 total and 2 distal gastrectomies, 1 total pancreatectomy as well as a central liver resection, one laparoscopic 5 segment resection and one 2, 3, 7 segment resection. We analyzed blood loss, duration of surgery, 90-day mortality, morbidity (Dindo-Clavien scoring), length of hospital-stay. RESULTS Blood loss ranged from 0 to 1500 ml, mean duration of surgery - from 150 to 560 min. There was one case of in-hospital mortality: one patient after a Whipple procedure died in 17 days after surgery due to massive arrosive bleeding. Complications developed in 8 patients, 3 of them required reoperation. Mean hospital-stay was 15±6 (8-29) days. CONCLUSION Advanced upper GI surgery for cancer is feasible in octagenarians and does not lead to inappropriate mortality and morbidity. Comprehensive preoperative examination alongside with enhanced recovery protocol are prerequisites for this type of surgery.
Collapse
Affiliation(s)
- V K Lyadov
- Medical and Rehabilitation Center under the Ministry of Health of Russian Federation, Moscow
| | - I A Kozyrin
- Medical and Rehabilitation Center under the Ministry of Health of Russian Federation, Moscow
| | - Z A Kovalenko
- Medical and Rehabilitation Center under the Ministry of Health of Russian Federation, Moscow
| |
Collapse
|
|
40
|
Improvement in postoperative mortality in elective gastrectomy for gastric cancer: Analysis of predictive factors in 1066 patients from a single centre. Eur J Surg Oncol 2017; 43:1330-1336. [PMID: 28359594 DOI: 10.1016/j.ejso.2017.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/08/2016] [Accepted: 01/03/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Gastrectomy represents the main treatment for gastric adenocarcinoma. This procedure is associated with substantial morbidity and mortality. The aim of this study was to evaluate the postoperative mortality changes across the study period and to identify predictive factors of 30-day mortality after elective gastrectomy for gastric cancer. METHODS This was a retrospective cohort study of a prospective database from a single centre. Patients treated with an elective gastrectomy from 1996 to 2014 for gastric adenocarcinoma were included. We compared postoperative mortality between four time periods: 1996-2000, 2001-2005, 2006-2010, and 2011-2014. Univariate and multivariate analyses were applied to identify predictors of 30-day postoperative mortality. RESULTS We included 1066 patients (median age 65 years; 67% male). The 30-day mortality rate was 4.7%. Mortality decreased across the four time periods; from 6.5% to 1.8% (P = 0.022). In the univariate analysis, age, ASA score, albumin <3.5, multivisceral resection, splenectomy, intrathoracic esophagojejunal anastomosis, R status, and T status were significantly associated with postoperative mortality. In the multivariate analysis, ASA class 3 (OR 10.06; CI 1.97-51.3; P = 0.005) and multivisceral resection (OR 1.6; CI 1.09-2.36; P = 0.016) were associated with higher postoperative 30-day mortality; surgery between 2011 and 2014 was associated with lower postoperative 30-day mortality (OR 0.55; CI 0.33-0.15; P = 0.030). CONCLUSION There was a decrease in postoperative 30-day mortality during this 18-year period at our institution. We have identified ASA score and multivisceral resection as predictors of 30-day mortality for elective gastrectomy for cancer.
Collapse
|
|
41
|
Liu KT, Wan JF, Yu GH, Bei YP, Chen X, Lu MZ. The recommended treatment strategy for locally advanced gastric cancer in elderly patients aged 75 years and older: a Surveillance, Epidemiology, and End Results database analysis. J Cancer Res Clin Oncol 2017; 143:313-320. [PMID: 27757528 DOI: 10.1007/s00432-016-2289-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND As patients aged 75 years and older are often underrepresented in randomized clinical trials, the external validity of clinical trials-based recommendations in older gastric patients was still controversial. The aim of this study is to explore the recommended treatment strategy for locally advanced gastric cancer in elderly patients. METHODS We designed our study to specifically evaluate the cancer-specific survival (CSS) of four subgroups of patients according to four different treatment modalities: adjuvant radiation (RT), surgery only, RT only and no surgery/no RT by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of survival outcomes and risk factors. RESULTS The 5-year CSS was 43.8 % in adjuvant RT, 28.5 % in surgery only, 14.9 % in RT only and 1.4 % in no surgery/no RT, which had significant difference in univariate log-rank test (P < 0.001) and multivariate Cox regression (P < 0.001). Moreover, we observed significant survival benefits in adjuvant RT group in all age categories, including age 75-79 years, age 80-84 years and age ≥85 years (all P < 0.001). CONCLUSIONS Surgery and adjuvant RT may be the recommended treatment strategy in elderly patients with locally advanced gastric cancer, especially for patients medically fit for the combined modality therapy.
Collapse
Affiliation(s)
- Kai-Tai Liu
- Department of Radiation Oncology, Lihuili Hospital, Ningbo Medical Center, No. 57, Xing'Ning Road, Ningbo, 315041, China
| | - Jue-Feng Wan
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Gen-Hua Yu
- Department of Radiation Oncology, Huzhou Central Hospital, Huzhou, Zhejiang Province, China
| | - Yan-Ping Bei
- Department of Radiation Oncology, Lihuili Hospital, Ningbo Medical Center, No. 57, Xing'Ning Road, Ningbo, 315041, China
| | - Xue Chen
- Department of Radiation Oncology, Lihuili Hospital, Ningbo Medical Center, No. 57, Xing'Ning Road, Ningbo, 315041, China
| | - Miao-Zhen Lu
- Department of Radiation Oncology, Lihuili Hospital, Ningbo Medical Center, No. 57, Xing'Ning Road, Ningbo, 315041, China.
| |
Collapse
|
|
42
|
Yoshikawa K, Shimada M, Higashijima J, Nakao T, Nishi M, Kashihara H, Takasu C. Limited lymph node dissection in elderly patients with gastric cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 63:91-5. [PMID: 27040060 DOI: 10.2152/jmi.63.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The number of elderly patients with gastric cancer is continuing to increase along with the life expectancy of the general population. The purpose of this study was to investigate both the impact of age on postoperative outcome and the effect of limited lymph node dissection for elderly patients. METHODS Patients were classified into the following three groups: Group A, ≥80 years old (n=44); Group B, 70-80 years old (n=139); Group C, <70 years old (n=219). Postoperative complication and survival rates were compared between the three groups Results: Limited lymph node dissection was performed significantly more frequently in Group A. In terms of surgery-related complications, no significant difference was seen between groups. In terms of general related complications, the complication rate increased with age, from 4% in Group C to 13% in Group B and 14% in Group A (p<0.05 each). Although limited lymph node dissection was frequently performed in Group A, cancer-specific survival showed no significant difference in R0 patients. CONCLUSIONS Limited lymph node dissection for gastric cancer did not affect the cancer-specific survival in elderly patients.
Collapse
|
|
43
|
Kikuchi H, Miyata H, Konno H, Kamiya K, Tomotaki A, Gotoh M, Wakabayashi G, Mori M. Development and external validation of preoperative risk models for operative morbidities after total gastrectomy using a Japanese web-based nationwide registry. Gastric Cancer 2017; 20:987-997. [PMID: 28285387 PMCID: PMC5658454 DOI: 10.1007/s10120-017-0706-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total gastrectomy is a relatively difficult and invasive procedure among gastrointestinal surgeries, and major morbidities following total gastrectomy can be serious and fatal. This study aimed to develop and validate preoperative risk models of morbidities associated with total gastrectomy using a Japanese web-based nationwide registry. METHODS The national clinical database was used to retrieve the records of 39,253 patients who underwent total gastrectomy in 1,841 hospitals between January 1, 2011 and December 31, 2012. RESULTS Mean patient age was 69.1 years, and 73.8% of the patients were male. The overall morbidity rate was 21.5%, which included 8.1% with surgical site infection (SSI), 4.5% with anastomotic leak, 5.0% with pancreatic fistula, 3.7% with pneumonia, 1.9% with prolonged ventilation, and 1.2% with renal failure. Sex, splenectomy, and Brinkman index were selected as common risk factors for SSI, anastomotic leak, and pancreatic fistula. Pancreatectomy was the most significant preoperative risk factor in the risk model of SSI and pancreatic fistula. Need of assistance with activities of daily living, chronic obstructive pulmonary disease, previous cerebrovascular disease, American Society of Anesthesiologists score class 3 and over, presence of esophageal cancer, and body mass index more than 25 were selected as common risk factors for pneumonia, prolonged ventilation over 48 h, and renal failure. CONCLUSIONS We have created the first reported risk models of morbidities associated with total gastrectomy, using a Japanese nationwide database. The risk models developed in this study may be useful to preoperatively predict operative morbidities in patients undergoing total gastrectomy.
Collapse
Affiliation(s)
- Hirotoshi Kikuchi
- The Japanese Society of Gastroenterological Surgery, Working Group Database Committee, Tokyo, Japan
| | - Hiroaki Miyata
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan ,National Clinical Database, Tokyo, Japan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan ,Hamamatsu University School of Medicine, 1-20-1 Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Kinji Kamiya
- The Japanese Society of Gastroenterological Surgery, Working Group Database Committee, Tokyo, Japan
| | - Ai Tomotaki
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan ,National Clinical Database, Tokyo, Japan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan ,National Clinical Database, Tokyo, Japan
| | - Go Wakabayashi
- The Japanese Society of Gastroenterological Surgery, Database Committee, Tokyo, Japan
| | - Masaki Mori
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| |
Collapse
|
|
44
|
Rausei S, Ruspi L, Rosa F, Morgagni P, Marrelli D, Cossu A, Cananzi FCM, Lomonaco R, Coniglio A, Biondi A, Cipollari C, Graziosi L, Fumagalli U, Casella F, Bertoli P, di Leo A, Alfieri S, Vittimberga G, Roviello F, Orsenigo E, Quagliuolo V, Montemurro S, Baiocchi G, Persiani R, Bencivenga M, Donini A, Rosati R, Sansonetti A, Ansaloni L, Zanoni A, Galli F, Dionigi G. Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2016; 42:1881-1889. [PMID: 27266816 DOI: 10.1016/j.ejso.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/15/2016] [Accepted: 05/05/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. METHODS In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. RESULTS Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. CONCLUSION Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.
Collapse
Affiliation(s)
- S Rausei
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy.
| | - L Ruspi
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
| | - F Rosa
- Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - P Morgagni
- General Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, FC, Italy
| | - D Marrelli
- Department of General Surgery and Oncology, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci, 53100 Siena, SI, Italy
| | - A Cossu
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy
| | - F C M Cananzi
- Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - R Lomonaco
- Surgery Unit, National Cancer Research Centre, Giovanni Paolo II, Viale Orazio Flacco 65, 70124 Bari, BA, Italy
| | - A Coniglio
- Department of Clinical and Experimental Sciences, Brescia University, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy
| | - A Biondi
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - C Cipollari
- Department of Surgery, University of Verona, Ospedale Borgo Trento, P.le A. Stefani 1, 37126 Verona, VR, Italy
| | - L Graziosi
- General and Emergency Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, PG, Italy
| | - U Fumagalli
- Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - F Casella
- Division of General Surgery, Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, RM, Italy
| | - P Bertoli
- Division of General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | - A di Leo
- Division of General Surgery, Rovereto Hospital, Corso Verona, 4, 38068 Rovereto, TN, Italy
| | - S Alfieri
- Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - G Vittimberga
- General Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, FC, Italy
| | - F Roviello
- Department of General Surgery and Oncology, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci, 53100 Siena, SI, Italy
| | - E Orsenigo
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy
| | - V Quagliuolo
- Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - S Montemurro
- Surgery Unit, National Cancer Research Centre, Giovanni Paolo II, Viale Orazio Flacco 65, 70124 Bari, BA, Italy
| | - G Baiocchi
- Department of Clinical and Experimental Sciences, Brescia University, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy
| | - R Persiani
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - M Bencivenga
- Department of Surgery, University of Verona, Ospedale Borgo Trento, P.le A. Stefani 1, 37126 Verona, VR, Italy
| | - A Donini
- General and Emergency Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, PG, Italy
| | - R Rosati
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy; Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - A Sansonetti
- Division of General Surgery, Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, RM, Italy
| | - L Ansaloni
- Division of General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | - A Zanoni
- Division of General Surgery, Rovereto Hospital, Corso Verona, 4, 38068 Rovereto, TN, Italy
| | - F Galli
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
| | - G Dionigi
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
| |
Collapse
|
|
45
|
Charalampakis N, Xiao L, Lin Q, Elimova E, Shimodaira Y, Harada K, Rogers JE, Mares J, Amlashi FG, Minsky BD, Das P, Hofstetter WL, Matamoros A, Sagebiel TL, Blum-Murphy MA, Lee JH, Weston B, Bhutani MS, Mansfield PF, Estrella JS, Badgwell BD, Ajani JA. Co-morbidities Rather than Age Impact Outcomes in Patients Receiving Preoperative Therapy for Gastroesophageal Adenocarcinoma. Ann Surg Oncol 2016; 24:2291-2301. [PMID: 27770339 DOI: 10.1245/s10434-016-5601-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Older patients with localized gastric adenocarcinoma (LGAC) have substantial postoperative morbidity and mortality; however, postoperative outcomes of the patients who receive preoperative chemotherapy and/or chemoradiation have not been reported. We examined the impact of age at baseline on potential predictors of postoperative outcomes. METHODS Patients with LGAC who were treated with chemotherapy and/or chemoradiation followed by surgery (n = 203) formed two groups: (1) ≥65 years old (n = 70) and (2) <65 years old (n = 133). We assessed postoperative morbidity and mortality as well as overall survival (OS) and progression-free survival (PFS). Potential predictors of 90-day postoperative outcomes were identified i) by age groups and ii) other clinical covariates. Descriptive statistics and survival analyses were utilized. RESULTS 90-day postoperative morbidity was similar in older and younger patients (61 % vs 58 %; P = 0.655). 90-day mortality was similar (3 % vs 0 %; P = 0.118). Major Clavien grade III/IV complications were similar (17 % vs 12 %; P = 0.392). OS and PFS were also similar for both groups (P = 0.863 and P = 0.558, respectively). Other factors, such as Charlson comorbidity index (P < 0.001) and median operative time (P = 0.002) were strongly associated with postoperative complications. CONCLUSION Our data show that older patients with LGAC generally have similar outcomes as do younger patients after preoperative therapy but comorbidity indices have significant impact on complications and the long-term outcomes rather than age.
Collapse
Affiliation(s)
- Nikolaos Charalampakis
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer, Houston, TX, USA
| | - Quan Lin
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Elena Elimova
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Yusuke Shimodaira
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Kazuto Harada
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Jane E Rogers
- Department of Pharmacy Clinical Programs, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jeannette Mares
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Fatemeh G Amlashi
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Aurelio Matamoros
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Tara L Sagebiel
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Mariela A Blum-Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Jeffrey H Lee
- Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Brian Weston
- Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Paul F Mansfield
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jeannelyn S Estrella
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
| |
Collapse
|
|
46
|
Passot G, Vaudoyer D, Messager M, Brudvik KW, Kim BJ, Mariette C, Glehen O. Is Extended Lymphadenectomy Needed for Elderly Patients With Gastric Adenocarcinoma? Ann Surg Oncol 2016; 23:2391-7. [PMID: 27169773 DOI: 10.1245/s10434-016-5260-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Extensive surgery is associated with greater mortality for elderly patients. For gastric adenocarcinoma (GA), it is unclear whether the benefit of an extended lymphadenectomy in this population outweighs the associated risks. This study aimed to determine the impact of lymphadenectomy on postoperative outcomes and survival for the elderly. OBJECTIVE To determine the impact of lymphadenectomy on postoperative outcomes and survival for elderly. METHODS From a cohort of 19 centers, patients who underwent resection of GA with curative intent between 1997 and 2010 were included in this study. Lymphadenectomy was defined according to the total number of lymph nodes in the surgical specimen (limited, <15; intermediate, 15-25; extended, >25). Postoperative outcomes and survival were compared between elderly (≥75 years) and younger patients and regarding the extent of lymphadenectomy for the elderly. RESULTS Of 1348 patients, 386 were elderly. The elderly presented with a higher American Society of Anesthesiologist (ASA) score (ASA 3-4: 45 vs. 16.5 %; p < 0.001) as well as greater postoperative morbidity (45 vs. 37 %; p = 0.009) and mortality (8 vs. 2.5 %; p < 0.001) despite less aggressive treatment including less neoadjuvant chemotherapy (5 vs. 20 %; p < 0.001) and adjuvant chemotherapy (7 vs. 44 %; p < 0.001), fewer total gastrectomies (41.5 vs. 60 %; p < 0.001), and less extended lymphadenectomy (38 vs. 48.5 %; p < 0.001). Among the elderly patients, limited lymphadenectomy (n = 116), intermediate lymphadenectomy (n = 125), and extended lymphadenectomy (n = 145) were comparable with respect to tumor stage, perioperative treatment, morbidity, and mortality. For the elderly patients, overall survival (OS) was 30.8 months, and disease-specific survival (DSS) was 63.9 months. The extent of the lymphadenectomy did not have an impact on OS or DSS for the elderly patients. CONCLUSION The expected benefit in terms of long-term survival did not justify an extended lymphadenectomy for elderly patients.
Collapse
Affiliation(s)
- Guillaume Passot
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France. .,EMR 3738, Lyon 1 University, Lyon, France.
| | - Delphine Vaudoyer
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France
| | - Mathieu Messager
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, France
| | - Kristoffer W Brudvik
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Norway
| | - Bradford J Kim
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, France
| | - Olivier Glehen
- Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| |
Collapse
|
|
47
|
Wang SL, Zhuang CL, Huang DD, Pang WY, Lou N, Chen FF, Zhou CJ, Shen X, Yu Z. Sarcopenia Adversely Impacts Postoperative Clinical Outcomes Following Gastrectomy in Patients with Gastric Cancer: A Prospective Study. Ann Surg Oncol 2016; 23:556-564. [DOI: 10.1245/s10434-015-4887-3] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
|
48
|
Eo WK, Chang HJ, Suh J, Ahn J, Shin J, Hur JY, Kim GY, Lee S, Park S, Lee S. The Prognostic Nutritional Index Predicts Survival and Identifies Aggressiveness of Gastric Cancer. Nutr Cancer 2015; 67:1260-7. [PMID: 26583916 DOI: 10.1080/01635581.2015.1082112] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Nutritional status has been associated with long-term outcomes in cancer patients. The prognostic nutritional index (PNI) is calculated by serum albumin concentration and absolute lymphocyte count, and it may be a surrogate biomarker for nutritional status and possibly predicts overall survival (OS) of gastric cancer. We evaluated the value of the PNI as a predictor for disease-free survival (DFS) in addition to OS in a cohort of 314 gastric cancer patients who underwent curative surgical resection. There were 77 patients in PNI-low group (PNI ≤ 47.3) and 237 patients in PNI-high group (PNI > 47.3). With a median follow-up of 36.5 mo, 5-yr DFS rates in PNI-low group and PNI-high group were 63.5% and 83.6% and 5-yr OS rates in PNI-low group and PNI-high group were 63.5% and 88.4%, respectively (DFS, P < 0.0001; OS, P < 0.0001). In the multivariate analysis, the only predictors for DFS were PNI, tumor-node-metastasis (TNM) stage, and perineural invasion, whereas the only predictors for OS were PNI, age, TNM stage, and perineural invasion. In addition, the PNI was independent of various inflammatory markers. In conclusion, the PNI is an independent prognostic factor for both DFS and OS, and provides additional prognostic information beyond pathologic parameters.
Collapse
Affiliation(s)
- Wan Kyu Eo
- a Department of Medical Oncology/Hematology , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Hye Jung Chang
- a Department of Medical Oncology/Hematology , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Jungho Suh
- a Department of Medical Oncology/Hematology , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Jin Ahn
- a Department of Medical Oncology/Hematology , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Jeong Shin
- a Department of Medical Oncology/Hematology , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Joon-Young Hur
- a Department of Medical Oncology/Hematology , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Gou Young Kim
- b Department of Pathology , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Sookyung Lee
- c Department of Sasang Constitutional Medicine , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Sora Park
- c Department of Sasang Constitutional Medicine , Kyung Hee University Hospital at Gangdong , Seoul , Republic of Korea
| | - Sanghun Lee
- d Department of Medical Consilence , Graduate School, Dankook University , Yongin-si , Republic of Korea
| |
Collapse
|
|
49
|
Parks RM, Rostoft S, Ommundsen N, Cheung KL. Peri-Operative Management of Older Adults with Cancer-The Roles of the Surgeon and Geriatrician. Cancers (Basel) 2015; 7:1605-21. [PMID: 26295261 PMCID: PMC4586786 DOI: 10.3390/cancers7030853] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/16/2015] [Accepted: 08/05/2015] [Indexed: 12/23/2022] Open
Abstract
Optimal surgical management of older adults with cancer starts pre-operatively. The surgeon plays a key role in the appropriate selection of patients and procedures, optimisation of their functional status prior to surgery, and provision of more intensive care for those who are at high risk of post-operative complications. The literature, mainly based on retrospective, non-randomised studies, suggests that factors such as age, co-morbidities, pre-operative cognitive function and intensity of the surgical procedure all appear to contribute to the development of post-operative complications. Several studies have shown that a pre-operative geriatric assessment predicts post-operative mortality and morbidity as well as survival in older surgical cancer patients. Geriatricians are used to working in multidisciplinary teams that assess older patients and make individual treatment plans. However, the role of the geriatrician in the surgical oncology setting is not well established. A geriatrician could be a valuable contribution to the treatment team both in the pre-operative stage (patient assessment and pre-operative optimisation) and the post-operative stage (patient assessment and treatment of medical complications as well as discharge planning).
Collapse
Affiliation(s)
- Ruth Mary Parks
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby DE 22 3DT, UK.
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo 0424, Norway.
| | - Nina Ommundsen
- Department of Geriatric Medicine, Akershus University Hospital, Po box 1000, Lørenskog 1478, Norway.
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby DE 22 3DT, UK.
| |
Collapse
|
|
50
|
Tran TB, Worhunsky DJ, Squires MH, Jin LX, Spolverato G, Votanopoulos KI, Schmidt C, Weber S, Bloomston M, Cho CS, Levine EA, Fields RC, Pawlik TM, Maithel SK, Norton JA, Poultsides GA. Outcomes of Gastric Cancer Resection in Octogenarians: A Multi-institutional Study of the U.S. Gastric Cancer Collaborative. Ann Surg Oncol 2015; 22:4371-9. [DOI: 10.1245/s10434-015-4530-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Indexed: 02/06/2023]
|