Surgical resection for gastric cancer in elderly patients: is there a difference in outcome?

Early and long-term outcome of gastrectomy for gastric cancer in elderly adults has been a subject of controversy and debate.

Clinical information was reviewed for patients undergoing gastrectomy for gastric cancer during an 11-year period (1990-2000) at the University of Tennessee Medical Center at Knoxville. Patient demographics, tumor characteristics, operative mortality and morbidity, survival, and length of hospitalization were reviewed.

Of 48 patients who underwent gastric resection for gastric adenocarcinoma, 24 were older than 70 and 24 younger than 70. There were no differences between the two groups regarding tumor characteristics, including location, tumor size, grade, gross pathology, lymph node involvement, lymphovascular invasion, and stage. In the elderly group, 75% underwent subtotal gastrectomy and 25% had total gastrectomy with or without resection of adjacent organs. In the younger patients, these numbers were 66.6% and 33.3%, respectively, which was statistically insignificant (P = 0.5). Five-year survival was 16.6% among elderly patients compared to 20.8% in the younger patients (P = 0.45). Half of the elderly patients and 39% of young patients had other comorbidities (P = 0.45). Postoperative mortality and morbidity was 8.33% and 33.3% in elderly patients, compared to 4.2% and 33.3%, respectively, in the younger group. These results were statistically insignificant (P = 0.4). The median postoperative length of stay was 15 days (95 percent confidence interval, 11-19 days) in younger patients compared to 18 days (95 percent confidence interval, 13-22 days) in the elderly group (P = 0.3).

This study suggests that gastrectomy can be carried out safely in elderly patients. The early and long-term outcomes in elderly patients (over age 70) are comparable to younger patients (under age 70). Age alone should not preclude gastric resection in elderly patients.