Gastric cancer surgery in elderly patients

Background: To investigate the value of individual risk-adapted therapy in geriatric patients, we performed a consecutive analysis of 363 patients undergoing potentially curative surgery for gastric cancer. Patients and Methods: All patients underwent extensive preoperative workup to assess surgical risk. The following criteria were evaluated in 3 age groups (< 60 years, 60-75 years, and > 75 years): comorbidity, tumor characteristics, type of resection, postoperative morbidity and mortality, recurrence rate, overall survival, and disease-free survival. Results: There was an increased rate of comorbidity in the higher age groups (51% vs 76% vs 83%; P < 0.05). Cardiovascular and pulmonary diseases were most common. There was a decrease in the rate of both total gastrectomy (74%, 54%, 46%; P < 0.05) and D2 lymphadenectomy (78%, 53%, 31%; P <0.05). The 30-day mortality in the 3 age groups was 0%, 1%, and 8%, respectively (P < 0.05). There was only a slight difference in tumor recurrence rate (35%, 37%, and 27%; P = 0.437), with no significant difference in 5-year cancer-related survival (61%, 53%, 61%; P = 0.199). Conclusions: Patient selection and risk-adapted surgery in elderly patients can result in acceptable therapeutic results comparable to younger patients. Limited surgery in elderly gastric cancer patients with high comorbidity does not necessarily compromise oncological outcome.