Gastric cancer surgery in the elderly

Area of Science:

• Oncology
• Geriatric Medicine
• Surgical Gastroenterology

Background:

• Gastric cancer incidence is declining in Japan, but the population of elderly patients (over 80) is increasing.
• This demographic shift necessitates understanding the surgical outcomes for very elderly patients with gastric cancer.

Purpose of the Study:

• To compare the resectability, pathological findings, surgical procedures, postoperative complications, and survival rates of gastric cancer patients over 80 years old with those aged 70-79.
• To evaluate the feasibility and outcomes of surgical treatment for gastric cancer in the octogenarian population.

Main Methods:

• Retrospective analysis of 40 gastric cancer patients aged 80-88 (Group 1) compared to 70-79 year olds (Group 2) from 1980-1989.
• Data collected included resectability rates, tumor stage, surgical procedures (total gastrectomy, combined resections), postoperative complications, and 5-year survival rates.

Main Results:

• Group 1 (over 80) had lower resectability (80% vs 89%) and early gastric cancer rates (25% vs 39%) compared to Group 2.
• More aggressive surgical procedures like total gastrectomy and combined resections were less frequent in Group 1.
• Postoperative complications were higher in Group 1 (25% vs 12%), though anastomotic leakage rates were similar.

Conclusions:

• Gastric cancer surgery in patients over 80 presents significant challenges, including lower resectability and higher complication rates.
• Despite these challenges, curative gastrectomy can achieve a considerable 5-year survival rate (61%) in octogenarian gastric cancer patients.
• Further research is needed to optimize surgical strategies and improve outcomes for this growing elderly population with gastric cancer.