The safety and efficacy of gastrectomy for gastric cancer among octogenarians: a western population-based study

The safety of minimally-invasive (MIG) and open gastrectomy (OG) in the older patients has been demonstrated in several international studies but has not been evaluated in the context of a large, Western population. The objective of this study was to evaluate the safety of gastrectomy by these two approaches among octogenarians in the United States.

The National Cancer Database (2010-2014) was queried for patients with gastric adenocarcinoma who underwent MIG or OG. Disease and treatment characteristics and outcomes were compared across age groups (<65, 65-79, ≥80 years). Multivariable regression analysis was used to identify factors associated with 90-day mortality.

13,845 patients were identified who met study inclusion criteria, of which 2140 patients (16%) were aged ≥80 years. Among octogenarians, MIG was associated with slightly decreased length of stay (11.2 vs 12.7 days, p < .001) compared to OG, with no difference in the rate of margin-positive resections, adequate lymph node sampling, or readmission (p = .30-0.77). 90-day mortality for both OG (17%) and MIG (17.2%) was significantly higher among octogenarians compared to younger patients (p < .001). Treatment at an academic facility was an independent predictor of decreased 90-day mortality among octogenarians (OR 0.534, 95%CI 0.322-0.886, p = .015).

In this Western population, we report comparable oncologic and post-operative outcomes between MIG and OG. However, the overall post-operative mortality rate among octogenarians remains unacceptably high. Better patient selection criteria for surgery and efforts to refer these patients to higher volume, academic facilities should be considered to improve patient outcomes.