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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Surgery for gastric cancer patients of age 85 and older: Multicenter survey
Hirotaka Konishi, Daisuke Ichikawa, Hiroshi Itoh, Kenichiro Fukuda, Naoki Kakihara, Manabu Takemura, Kaori Okugawa, Kiyoshi Uchiyama, Masashi Nakata, Hiroshi Nishi, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji
Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
Hiroshi Itoh, Department of Surgery, North Medical Center, Kyoto Prefectural University of Medicine, Yosa-gun, Kyoto 629-2261, Japan
Kenichiro Fukuda, Department of Surgery, Saiseikai Shigaken Hospital, Ritto, Shiga 520-3046, Japan
Naoki Kakihara, Department of Surgery, Japanese Red Cross Kyoto Daini Hospital, Kamigyo-ku, Kyoto 602-8026, Japan
Manabu Takemura, Department of Surgery, Osaka General Hospital of West Japan Railway Company, Abeno-ku, Osaka 545-0053, Japan
Kaori Okugawa, Department of Surgery, Omihachiman Community Medical Center, Omihachiman, Shiga 523-0082, Japan
Kiyoshi Uchiyama, Department of Surgery, Kyoto Okamoto Memorial Hospital, Kumiyama-cho, Kyoto 613-0034, Japan
Masashi Nakata, Department of Surgery, Kyoto Yamashiro General Medical Center, Kizugawa, Kyoto 619-0214, Japan
Hiroshi Nishi, Department of Surgery, Saiseikai Kyoto Hospital, Nagaokakyo, Kyoto 617-0814, Japan
Author contributions: Konishi H and Itoh H contributed equally to this study; Konishi H, Ichikawa D, Itoh H and Otsuji E designed the research; Konishi H, Ichikawa D, Itoh H, Fukuda K, Kakihara N, Takemura M, Okugawa K, Uchiyama K, Nakata M, Nishi H, Kosuga T, Komatsu S and Okamoto K treated the patients and collected the data; Konishi H, Ichikawa D and Itoh H analyzed the data; Konishi H, Ichikawa D, Itoh H and Otsuji E wrote the manuscript.
Institutional review board statement: The study was reviewed and approved by the Faculty of Science Ethics Committee at Kyoto Prefectural University of Medicine (RBMR-C-179).
Informed consent statement: All study participants provided informed written consent prior to their treatments and study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest related to this study or its publication.
Data sharing statement: The technical appendix, statistical code and dataset are available from Hirotaka Konishi at h-koni7@koto.kpu-m.ac.jp.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Daisuke Ichikawa, MD, PhD, Assistant Professor, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-ku, Kyoto 602-8566, Japan.
ichikawa@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: October 19, 2016
Peer-review started: October 20, 2016
First decision: November 9, 2016
Revised: November 26, 2016
Accepted: January 11, 2017
Article in press: January 11, 2017
Published online: February 21, 2017
Processing time: 123 Days and 21.4 Hours
AIM
To investigate the surgical therapies for gastric cancer (GC) patients of age 85 or older in a multicenter survey.
METHODS
Therapeutic opportunities for elderly GC patients have expanded in conjunction with extended life expectancy. However, the number of cases encountered in a single institution is usually very small and surgical therapies for elderly GC patients have not yet been standardized completely. In the present study, a total of 134 GC patients of age 85 or older who underwent surgery in 9 related facilities were retrospectively investigated. The relationships between surgical therapies and clinicopathological or prognostic features were analyzed.
RESULTS
Eighty-nine of the patients (66%) presented with a comorbidity, and 26 (19% overall) presented with more than two comorbidities. Radical lymphadenectomy was performed in 59 patients (44%), and no patient received pre- or post-operative chemotherapy. Forty of the patients (30%) experienced perioperative complications, but no surgical or perioperative mortality occurred. Laparoscopic surgery was performed in only 12 of the patients (9.0%). Univariate and multivariate analyses of the 113 patients who underwent R0 or R1 resection identified the factors of pT3/4 and limited lymphadenectomy as predictive of worse prognosis (HR = 4.68, P = 0.02 and HR =2.19, P = 0.05, respectively). Non-cancer-specific death was more common in cStage I patients than in cStage II or III patients. Limited lymphadenectomy correlated with worse cancer-specific survival (P = 0.01), particularly in cStage II patients (P < 0.01). There were no relationships between limited lymphadenectomy and any comorbidities, except for cerebrovascular disease (P = 0.07).
CONCLUSION
Non-cancer-specific death was not negligible, particularly in cStage I, and gastrectomy with radical lymphadenectomy appears to be an effective treatment for cStage II elderly GC patients.
Core tip: Therapeutic opportunities for elderly gastric cancer (GC) patients have expanded. This multicenter study investigated surgical therapies for GC patients of age 85 or older. Cancer-specific and overall survival rates were 100% and 56% in cStage I. The factors of pT3/4 and limited lymphadenectomy were predictive of worse prognosis. Cancer-specific survival in cStage II with radical lymphadenectomy was significantly better, but did not significantly benefit cStage III. Only cerebrovascular disease was related with limited lymphadenectomy. Non-cancer-specific death was not negligible, particularly in cStage I, and gastrectomy with radical lymphadenectomy appeared to be an effective treatment for cStage II elderly patients.
