Surgery for gastric cancer patients of age 85 and older: Multicenter survey

AIM To investigate the surgical therapies for gastric cancer(GC) patients of age 85 or older in a multicenter survey.METHODS Therapeutic opportunities for elderly GC patients have expanded in conjunction with extended life expectancy. However, the number of cases encountered in a single institution is usually very small and surgical therapies for elderly GC patients have not yet been standardized completely. In the present study, a total of 134 GC patients of age 85 or older who underwent surgery in 9 related facilities were retrospectively investigated. The relationships between surgical therapies and clinicopathological or prognostic features were analyzed.RESULTS Eighty-nine of the patients(66%) presented with a comorbidity, and 26(19% overall) presented with more than two comorbidities. Radical lymphadenectomy was performed in 59 patients(44%), and no patient received pre- or post-operative chemotherapy. Forty of the patients(30%) experienced perioperative complications, but no surgical or perioperative mortality occurred. Laparoscopic surgery was performed in only 12 of the patients(9.0%). Univariate and multivariate analyses of the 113 patients who underwent R0 or R1 resection identified the factors of p T3/4 and limited lymphadenectomy as predictive of worse prognosis(HR = 4.68, P = 0.02 and HR =2.19, P = 0.05, respectively). Non-cancer-specific death was more common in c Stage Ⅰ patients than in c Stage Ⅱ or Ⅲ patients. Limited lymphadenectomy correlated with worse cancer-specific survival(P = 0.01), particularly in c Stage Ⅱ patients(P < 0.01). There were no relationships between limited lymphadenectomy and any comorbidities, except for cerebrovascular disease(P = 0.07). CONCLUSION N o n- c a n c e r- s p e c i f i c d e a t h w a s n o t n e g l i g i b l e, particularly in c Stage Ⅰ, and gastrectomy with radical lymphadenectomy appears to be an effective treatment for cS tage Ⅱ elderly GC patients.