The risk factor for gastric cancer surgery is expected to be characteristic feature of elderly in comparison to non-elderly due to decline in organ function and co-morbidities related to aging. However, the differences in the risk factors for gastric cancer surgery between elderly and non-elderly have not been evaluated. The aim of this study was to identify characteristics of risk factors of gastric cancer surgery for elderly.
This retrospective study examined 2500 patients who underwent gastrectomy with D1, D1+, D2, or D3 lymphadenectomy during 2000 to 2016 at Kanagawa Cancer Center hospital with curative intent. Patients were divided into two groups according to age, more than 75 years old (n = 406), E group; and less than 75 years old (n = 2094), Y group. Multivariate logistic regression analysis was performed to assess the independent contribution of variables to postoperative complication in each group.
Mean age was 61.3 y.o. in Y group and 78.3 y.o. in E groups. Charlson Index (0/1/2) was 1523/557/14 in Y group, and 228/173/5 in E group (p < 0.001). ECOG-PS was (0/1/2/3) was 1918/173/2/1 in Y group, and 345/59/1/1 in E group (p < 0.001). Extent of the stomach resection (total/proximal/distal) was 768/37/1289 in Y group, and 149/4/253 in E group. Stage (I/II/III/IV) was 1227/323/331/213 in Y group, 225/58/86/37 in E group. Postoperative complications were observed in 267 patients (13%) in Y group and 84 patients (21%) in E group. The most frequent complication was pancreatic fistula (n = 41), followed by anastomotic leakage (n = 36) in Y group, and pneumonia (n = 20), followed by anastomotic leakage (n = 19) in E group. Multivariate analysis identified male sex (odds ratio: 1.87), and total gastrectomy (odds ratio: 1.58) as independent predictors of postoperative complications in Y group, and male sex (odds ratio: 3.01), stage IV (odds ratio: 2.54), and Charlson score > 1 (odds ratio: 1.76) in E group.
In elderly patients, co-morbidity more strongly affects postoperative complications compared with non-elderly patients. Co-morbidities especially in major organ function should be taken into consideration for future trials evaluating gastric cancer surgery for elderly patients.
Clinical trial identification
Legal entity responsible for the study
Kanagawa Cancer Center.
Has not received any funding.
T. Hayashi: Personal fee, Lectual fee Chugai, Ono, MSD. T. Yoshikawa: Personal fee, Lectual fee Taiho, Chugai, Yakult, Ono, MSD. All other authors have declared no conflicts of interest.