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Eom BW. Surgical Outcomes of Patients Undergoing Gastrectomy for Gastric Cancer: Does the Age Matter? J Gastric Cancer 2022; 22:157-159. [PMID: 35938362 PMCID: PMC9359883 DOI: 10.5230/jgc.2022.22.e20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
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2
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Leduc VR, Santos FADV, Oliveira PSVD, Lomba GSDPD, Figueiredo GDD, Kalil JP, Wainstein AJA, Drummond-Lage AP. ARE THERE DIFFERENCES IN LAPAROSCOPIC GASTRECTOMY MORBIDITY AND MORTALITY BETWEEN YOUNG AND OLDER? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2022; 34:e1617. [PMID: 35019129 PMCID: PMC8735311 DOI: 10.1590/0102-672020210002e1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/30/2021] [Indexed: 12/09/2022]
Abstract
Background: Due to the longer life expectancy and consequently an increase in the elderly population, a higher incidence of gastric cancer is expected in this population in the coming decades.
Aim: To compare the results of laparoscopic GC surgical treatment between individuals aged<65 years (group I) and ≥ 65 years (group II), according to clinical, surgical, and histopathological characteristics.
Methods: A observational retrospective study was performed by analyzing medical charts of patients with gastric cancer undergoing total or subtotal laparoscopic gastrectomy for curative purposes by a single oncologic surgery team.
Results: Thirty-six patients were included in each group. Regarding the ASA classification, 31% of the patients in group I was ASA 1, compared to 3.1% in group II. The mean number of concomitant medications in group II was statistically superior to group I (5±4.21 x 1.42±3.08, p<0.001). Subtotal gastrectomy was the most performed procedure in both groups (69.4% and 63.9% in groups I and II, respectively) due to the high prevalence of distal tumors in both groups, 54.4% group I and 52.9% group II. According to Lauren's classification, group I presented a predominance of diffuse tumors (50%) and group II the intestinal type (61.8%). There was no difference between the two groups regarding the number of resected lymph nodes and lymph node metastases and the days of hospitalization and mortality.
Conclusion: Laparoscopic gastrectomy showed to be a safe procedure, without a statistical difference in morbidity, mortality, and hospitalization time between both groups.
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Affiliation(s)
| | | | | | | | | | | | - Alberto Julius Alves Wainstein
- Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, MG, Brazil.,Oncad Surgical Oncology, Belo Horizonte, MG, Brazil
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Chen E, Senders ZJ, Hardacre J, Kim J, Ammori J. Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric adenocarcinoma. J Surg Oncol 2020; 121:1015-1021. [PMID: 32090338 DOI: 10.1002/jso.25866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Current data are conflicting as to whether the outcomes of octogenarians undergoing resection for esophagogastric adenocarcinoma are comparable to younger patients. This study aims to compare perioperative outcomes and survival of patients ≥80 years old with younger patients undergoing curative resection for esophagogastric adenocarcinoma. METHODS Retrospective data were collected on 190 patients who underwent resection with curative intent for adenocarcinomas found in the stomach and esophagogastric junction from 2004 to 2015 at a single institution. RESULTS Of the 190 patients, 34 (18%) were ≥80 years old. Octogenarians were more likely to have chronic kidney disease (CKD) and were less likely to have received neoadjuvant chemotherapy. Pathologic features were similar between groups. Octogenarians' tumors were more likely to be located in the gastric body as compared to the esophagogastric junction in younger patients. Although the length of stay was comparable, octogenarians were significantly less likely to be discharged home (P < .01). Both groups had a single death during the index admission. Incidence and severity of 90 days postoperative complications were not significantly different between groups. There was no difference in 30-day, 90-day, 1-year, or median survival. CONCLUSIONS Perioperative outcomes and survival of octogenarians undergoing curative resection for esophagogastric cancer are comparable to younger patients at our institution.
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Affiliation(s)
- Eric Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Zachary J Senders
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey Hardacre
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Julian Kim
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - John Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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Lopez-Lopez V, Gómez-Ruiz AJ, Eshmuminov D, Cascales-Campos PA, Alconchel F, Arevalo-Perez J, Robles Campos R, Parrilla Paricio P. Surgical oncology in patients aged 80 years and older is associated with increased postoperative morbidity and mortality: A systematic review and meta-analysis of literature over 25 years. Surg Oncol 2019; 33:81-95. [PMID: 32561103 DOI: 10.1016/j.suronc.2019.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The study aim is to analyze the evolution over the last 25 years of the results reported after abdominal oncological surgery in patients aged 80 years of age and older. The primary endpoint was morbidity and mortality in this group of patients; the secondary endpoint was overall survival. METHODS A systematic search strategy was used to browse through Medline/PubMed, EMBASE, Scopus, ClinicalTrials.gov, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials using a combination of standardized index terms. Studies published between 1997 and 2017 were selected. Only those studies that showed morbidity and mortality after digestive and hepatobiliary tract oncological surgery in individuals aged 80 years and older were included. The PROSPERO registration number is CRD42018087921. PRISMA and MOOSE guidelines were applied. RESULTS A total of 79 studies were included, categorized by origin of malignancy: esophageal (7), stomach (26), liver (4), pancreas (19), and colorectal (23). Compared with the non-elderly group, the elderly group had similar esophageal morbidity with higher mortality (RR 2.51, 1.50 to 4.21; P = 0.0005); higher gastric morbidity (RR 1.25, 1.09 to 1.43; P = 0.001), and mortality (RR 2.51, 1.81 to 3.49; P = 0.0001); similar liver morbidity and mortality; higher pancreatic morbidity (RR 1.17, 1.03 to 1.33; P = 0.02) and mortality (RR 2.37, 1.86 to 3.03; P < 0.00001); and similar colorectal morbidity with higher mortality (RR 4.44, 1.91 to 10.32; P = 0.005). CONCLUSION Oncological surgery of most abdominal visceral tumors is associated with increased morbidity and mortality in patients older than 80 years.
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Affiliation(s)
- V Lopez-Lopez
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - A J Gómez-Ruiz
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain.
| | - D Eshmuminov
- Department of Surgery, Swiss HPB and Transplantation Centre, University Hospital Zurich, Zurich, Switzerland
| | | | - F Alconchel
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - J Arevalo-Perez
- Memorial Sloan Kettering Cancer Center. Radiology Departament, New York, USA
| | - R Robles Campos
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
| | - P Parrilla Paricio
- Virgen de La Arrixaca Clinic and University Hospital, IMIB, Murcia, Spain
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Ciesielski M, Kruszewski WJ, Szajewski M, Walczak J, Spychalska N, Szefel J, Zieliński J. Extremely High Mortality Rate after a Successful Gastrectomy for Cancer in Older Adults. J Gastric Cancer 2019; 19:202-211. [PMID: 31245165 PMCID: PMC6589425 DOI: 10.5230/jgc.2019.19.e16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/27/2019] [Accepted: 04/19/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Poor physiological reserve for withstanding major cancer surgery in older adults is an important concern in the selection of patients for oncologic gastrectomy. The present study aimed to analyze mortality patterns among patients who underwent gastrectomy for cancer according to age groups. The primary outcomes of this study were early- and middle-term results: 30-day and 3-, 6-, 12-, and 36-month mortality rates. MATERIALS AND METHODS A retrospective review of 288 patients who underwent surgical resection for gastric cancer in two centers was carried out. Patients were stratified into four groups according to age: 29-50 years (group I, n=27), 51-65 years (group II, n=117), 66-75 years (group III, n=81), and 76-92 years (group IV, n=58). Statistical calculations focused on the differences in the survival rates between groups I and II as well as between groups II and IV. RESULTS The middle-aged patients (group II) had significantly better 3-year survival than either the youngest (group I) or the oldest patients (group IV). The 6-month mortality rates were 16.9% in group III and 29.3% in group IV. Two-thirds of the patients from groups III and IV who died between 2 and 6 months after surgery had an uneventful postoperative course. CONCLUSIONS Age is an important prognostic factor of middle-term survival after gastrectomy for cancer. Geriatric assessment and better patient selection for major surgery for cancer are required to improve the outcome of gastrectomy for cancer in patients aged over 75 years.
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Affiliation(s)
- Maciej Ciesielski
- Department of Oncological Surgery, Gdynia Oncology Centre, Pomeranian Hospitals, Gdynia, Poland
- Division of Propedeutics of Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wiesław Janusz Kruszewski
- Department of Oncological Surgery, Gdynia Oncology Centre, Pomeranian Hospitals, Gdynia, Poland
- Division of Propedeutics of Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Mariusz Szajewski
- Department of Oncological Surgery, Gdynia Oncology Centre, Pomeranian Hospitals, Gdynia, Poland
- Division of Propedeutics of Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jakub Walczak
- Department of Oncological Surgery, Gdynia Oncology Centre, Pomeranian Hospitals, Gdynia, Poland
| | - Natalia Spychalska
- Department of Oncological Surgery, Gdynia Oncology Centre, Pomeranian Hospitals, Gdynia, Poland
| | - Jarosław Szefel
- Department of Oncological Surgery, Gdynia Oncology Centre, Pomeranian Hospitals, Gdynia, Poland
- Division of Propedeutics of Oncology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Zieliński
- Department of Oncological Surgery, Medical University of Gdańsk, Gdańsk, Poland
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Lin JX, Yi BC, Yoon C, Li P, Zheng CH, Huang CM, Yoon SS. Comparison of Outcomes for Elderly Gastric Cancer Patients at Least 80 Years of Age Following Gastrectomy in the United States and China. Ann Surg Oncol 2018; 25:3629-3638. [PMID: 30218243 DOI: 10.1245/s10434-018-6757-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare gastric cancer (GC) patients aged 80 years or older undergoing gastrectomy at two high-volume cancer centers in the US and China. METHODS Patients aged ≥ 80 years who underwent R0 resection at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, USA (n = 159), and Fujian Medical University Union Hospital (FMUUH) in Fujian, China (n = 118) from January 2000 to December 2013 were included. Demographic, surgical, and pathologic variables were compared, and factors associated with survival were determined via multivariate analysis. RESULTS The number of patients increased annually in the FMUUH cohort but not in the MSKCC cohort. Patients at MSKCC were slightly older (mean age 83.7 vs. 82.7 years), more commonly female (38 vs. 19%), and had higher average body mass index (BMI; 26 vs. 23). Treatment at FMUUH more frequently employed total gastrectomy (59 vs. 20%) and laparoscopic surgery (65 vs. 7%), and less frequently included adjuvant therapy (11 vs. 18%). In addition, FMUUH patients had larger tumors of more advanced T, N, and TNM stage. Morbidity (35 vs. 25%, p = 0.08) and 30-day mortality (2.5 vs. 3.3%, p = 0.67) were similar between the cohorts. For each TNM stage, there was no significant difference between MSKCC and FMUUH patients in 5-year overall survival and disease-specific survival (DSS). TNM stage was the only independent predictor of DSS for both cohorts. CONCLUSIONS Patients ≥ 80 years of age selected for gastrectomy for GC at MSKCC and FMUUH had acceptable morbidity and mortality, and DSS was primarily dependent on TNM stage.
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Affiliation(s)
- Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Brendan C Yi
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Changhwan Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Sam S Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Liu N, Yang H, Wang H. miR-598 acts as a tumor suppressor in human gastric cancer by targeting IGF-1R. Onco Targets Ther 2018; 11:2911-2923. [PMID: 29844688 PMCID: PMC5961641 DOI: 10.2147/ott.s166597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background In recent years, the aberrant expression of miR-598 in tumorigenesis has been demonstrated, as well as the fact that the IGF-1R pathway is also involved in the development of human gastric cancer (GC). The present study aimed to investigate the molecular mechanisms underlying miR-598-regulated IGF-1R expression in human GC. Materials and methods We analyzed the expression of miR-598 and IGF-1R in GC samples and cells, and evaluated the clinical significance of miR-598 and IGF-1R in GC patients. Furthermore, in vitro and in vivo assays were used to investigate the molecular mechanisms of miR-598 and IGF-1R. Results miR-598 expression was frequently downregulated in GC tissues and cells, and significantly correlated with poor prognosis, vascular invasion, TNM stage, and lymph node metastases as well as IGF-1R expression. The overexpression of miR-598 obviously inhibited cell proliferation, migration, invasion, and induced cell cycle arrest in the G1/S phase, and increased the apoptosis of GC cells. The overexpression of miR-598 also significantly inhibited ERK1/2 and Akt phosphorylation level. In vivo assay validated the inhibitory effect of miR-598 on tumor growth. Further studies showed that miR-598 inhibited IGF-1R protein expression by directly targeting its 3′-UTR. Besides, over-expression of IGF-1R reversed the inhibitory effects of miR-598, while suppression of IGF-1R expression showed inverse effects. Conclusion miR-598 suppresses GC cell proliferation, migration and invasion by directly targeting IGF-1R expression. Thus, miR-598 may be a useful target for GC patients.
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Affiliation(s)
- Na Liu
- Intensive Care Unit, Shandong Provincial Third Hospital, Shandong, China
| | - Hua Yang
- Intensive Care Unit, Chiping County People's Hospital, Shandong, China
| | - Hong Wang
- Department of General Surgery, Shandong Provincial Third Hospital, Shandong, China
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Surgical treatment outcomes of patients with T1-T2 gastric cancer: does the age matter when excellent treatment results are expected? World J Surg Oncol 2018; 16:79. [PMID: 29661204 PMCID: PMC5902993 DOI: 10.1186/s12957-018-1388-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The proportion of early gastric cancer stages is increasing, as is the incidence of gastric cancer among the elderly population. Therefore, this study was designed to analyze surgical treatment outcomes of T1-T2 gastric cancer in elderly patients. METHODS A total of 457 patients with T1-T2 gastric cancer who underwent gastrectomy between 2005 and 2015 were enrolled in this retrospective study. Patients were classified into two groups according to age (< 70 years versus ≥ 70 years). Clinicopathological features, surgical treatment results, and clinical outcomes were compared between the groups. RESULTS Higher ASA score (ASA 3/4), differentiated cancer, and intestinal-type tumors were more common in elderly patients. Postoperative complication rates were similar between the two groups; however, postoperative mortality rates were significantly higher in the elderly group. Higher ASA score was independently associated with postoperative complications in the elderly group. Furthermore, severe postoperative complications were found as an independent factor associated with higher 90-day mortality rate. Elderly patients had a significantly poorer 5-year overall survival rate. Two surgery-related factors-total gastrectomy and complicated postoperative course-were revealed as independent prognostic factors for poor overall survival in the elderly group. CONCLUSIONS Despite higher postoperative mortality rate and poorer overall survival results, elderly patients with gastric cancer should be considered for radical surgery. ASA score may be useful for predicting surgical treatment outcomes in elderly patients undergoing surgery for GC and hence assists clinicians in planning treatment strategies for each individual patient.
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Pisanu A, Montisci A, Piu S, Uccheddu A. Curative Surgery for Gastric Cancer in the Elderly: Treatment Decisions, Surgical Morbidity, Mortality, Prognosis and Quality of Life. TUMORI JOURNAL 2018; 93:478-84. [DOI: 10.1177/030089160709300512] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Surgical risk is deemed to be higher in the aged population because there are often comorbidities that may affect the postoperative result. This consideration is important for the treatment decision-making for gastric cancer in the elderly. The aim of this study was to identify factors influencing mortality, morbidity, survival and quality of life after curative surgery for gastric cancer in patients aged 75 years and older, and to plan their appropriate management. Methods and Study Design From January 1993 to December 2004, 135 patients underwent surgery at our department because of gastric cancer. Ninety-four of these patients (69.6%) underwent potentially curative gastrectomy. A cross-sectional study of 23 patients aged 75 years and older and 71 younger patients who underwent curative gastrectomy was carried out: patient characteristics, tumor characteristics, management, morbidity, mortality, survival, and quality of life were evaluated. Results Elderly patients had significantly more comorbidities and a poorer nutritional status than younger patients. The surgical procedures were similar in both groups and the overall morbidity rate was 27.9% and the overall mortality rate 8.5%. Medical mortality was significantly higher in elderly patients, and the presence of comorbidities was the only independent factor affecting mortality. The 5-year survival rate was 56.2% in the older group versus 62.1% in the younger group and tumor stage was the only prognostic factor influencing survival. Quality of life after surgery was similar in both groups. The significantly better postoperative functional outcome after subtotal gastrectomy suggested a better compliance of elderly patients with subtotal than total gastrectomy. Conclusions In the elderly, surgical strategies must be modulated on the basis of comorbidities, tumor stage and future quality of life. Since elderly patients have no worse prognosis than younger patients, age is not a contraindication to curative resection for gastric cancer. Subtotal gastrectomy should be the procedure of choice mainly in elderly patients as it offers better quality of life.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Alessandro Montisci
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Sara Piu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
| | - Alessandro Uccheddu
- Department of Surgery, Clinica Chirurgica of the University of Cagliari, Cagliari, Italy
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Nelen SD, van Putten M, Lemmens VEPP, Bosscha K, de Wilt JHW, Verhoeven RHA. Effect of age on rates of palliative surgery and chemotherapy use in patients with locally advanced or metastatic gastric cancer. Br J Surg 2017; 104:1837-1846. [PMID: 28791679 DOI: 10.1002/bjs.10621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/20/2017] [Accepted: 05/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study assessed trends in the treatment and survival of palliatively treated patients with gastric cancer, with a focus on age-related differences. METHODS For this retrospective, population-based, nationwide cohort study, all patients diagnosed between 1989 and 2013 with non-cardia gastric cancer with metastasized disease or invasion into adjacent structures were selected from the Netherlands Cancer Registry. Trends in treatment and 2-year overall survival were analysed and compared between younger (age less than 70 years) and older (aged 70 years or more) patients. Analyses were done for five consecutive periods of 5 years, from 1989-1993 to 2009-2013. Multivariable logistic regression analysis was used to examine the probability of undergoing surgery. Multivariable Cox regression analysis was used to identify independent risk factors for death. RESULTS Palliative resection rates decreased significantly in both younger and older patients, from 24·5 and 26·2 per cent to 3·0 and 5·0 per cent respectively. Compared with patients who received chemotherapy alone, both younger (21·6 versus 6·3 per cent respectively; P < 0·001) and older (14·7 versus 4·6 per cent; P < 0·001) patients who underwent surgery had better 2-year overall survival rates. Multivariable analysis demonstrated that younger and older patients who received chemotherapy alone had worse overall survival than patients who had surgery only (younger: hazard ratio (HR) 1·22, 95 per cent c.i. 1·12 to 1·33; older: HR 1·12, 1·01 to 1·24). After 2003 there was no association between period of diagnosis and overall survival in younger or older patients. CONCLUSION Despite changes in the use of resection and chemotherapy as palliative treatment, overall survival rates of patients with advanced and metastatic gastric cancer did not improve.
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Affiliation(s)
- S D Nelen
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M van Putten
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - V E P P Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, 's -Hertogenbosch, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
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11
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Fujiwara Y, Fukuda S, Tsujie M, Ishikawa H, Kitani K, Inoue K, Yukawa M, Inoue M. Effects of age on survival and morbidity in gastric cancer patients undergoing gastrectomy. World J Gastrointest Oncol 2017; 9:257-262. [PMID: 28656076 PMCID: PMC5472556 DOI: 10.4251/wjgo.v9.i6.257] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/24/2017] [Accepted: 05/18/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score. METHODS We enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old (Group A), and 333 patients were aged < 79 years old (Group B). We compared the surgical outcomes and survival of the two groups after IPTW. RESULTS Postoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B (P < 0.05). Overall survival (OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage I disease, OS was significantly lower in Group A (P < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection were independent prognostic values for OS. CONCLUSION When the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.
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12
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Tandon A, Rajendran I, Aziz M, Kolamunnage-Dona R, Nunes QM, Shrotri M. Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre. Ann R Coll Surg Engl 2017; 99:325-331. [PMID: 27869493 PMCID: PMC5449677 DOI: 10.1308/rcsann.2016.0344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.
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Affiliation(s)
- A Tandon
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
| | - I Rajendran
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
| | - M Aziz
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
| | - R Kolamunnage-Dona
- MRC North West Hub for Trials Methodology Research , Liverpool , UK
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool , Liverpool , UK
| | - Q M Nunes
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
- NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University, Hospitals NHS Trust, Department of Molecular and Clinical Cancer Medicine, University of Liverpool , Liverpool , UK
| | - M Shrotri
- Department of General Surgery, Aintree University Hospital , Liverpool , UK
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Ruspi L, Galli F, Pappalardo V, Inversini D, Martignoni F, Boni L, Dionigi G, Rausei S. Lymphadenectomy in elderly/high risk patients: should it be different? Transl Gastroenterol Hepatol 2017; 2:5. [PMID: 28217755 DOI: 10.21037/tgh.2016.12.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/27/2016] [Indexed: 12/26/2022] Open
Abstract
The global aging of population will lead a greater number of elderly patients to undergo surgical procedure in a near future. Concerning gastric cancer, the impact of lymphadenectomy on survival has been demonstrated in RCTs, and extended lymphadenectomy is now considered as gold standard of treatment in non-early tumors. However, the role of age as a prognostic factor and the benefit of extended surgery in elderly/high-risk patients are not clearly defined yet. From our revision of literature, it seems that surgery for gastric cancer may have a further tailorization, considering not only the stage of disease, but also patients' age and comorbidities.
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Affiliation(s)
- Laura Ruspi
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Federica Galli
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Vincenzo Pappalardo
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Davide Inversini
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Francesco Martignoni
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Luigi Boni
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Gianlorenzo Dionigi
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Stefano Rausei
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
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Charalampakis N, Xiao L, Lin Q, Elimova E, Shimodaira Y, Harada K, Rogers JE, Mares J, Amlashi FG, Minsky BD, Das P, Hofstetter WL, Matamoros A, Sagebiel TL, Blum-Murphy MA, Lee JH, Weston B, Bhutani MS, Mansfield PF, Estrella JS, Badgwell BD, Ajani JA. Co-morbidities Rather than Age Impact Outcomes in Patients Receiving Preoperative Therapy for Gastroesophageal Adenocarcinoma. Ann Surg Oncol 2016; 24:2291-2301. [PMID: 27770339 DOI: 10.1245/s10434-016-5601-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Older patients with localized gastric adenocarcinoma (LGAC) have substantial postoperative morbidity and mortality; however, postoperative outcomes of the patients who receive preoperative chemotherapy and/or chemoradiation have not been reported. We examined the impact of age at baseline on potential predictors of postoperative outcomes. METHODS Patients with LGAC who were treated with chemotherapy and/or chemoradiation followed by surgery (n = 203) formed two groups: (1) ≥65 years old (n = 70) and (2) <65 years old (n = 133). We assessed postoperative morbidity and mortality as well as overall survival (OS) and progression-free survival (PFS). Potential predictors of 90-day postoperative outcomes were identified i) by age groups and ii) other clinical covariates. Descriptive statistics and survival analyses were utilized. RESULTS 90-day postoperative morbidity was similar in older and younger patients (61 % vs 58 %; P = 0.655). 90-day mortality was similar (3 % vs 0 %; P = 0.118). Major Clavien grade III/IV complications were similar (17 % vs 12 %; P = 0.392). OS and PFS were also similar for both groups (P = 0.863 and P = 0.558, respectively). Other factors, such as Charlson comorbidity index (P < 0.001) and median operative time (P = 0.002) were strongly associated with postoperative complications. CONCLUSION Our data show that older patients with LGAC generally have similar outcomes as do younger patients after preoperative therapy but comorbidity indices have significant impact on complications and the long-term outcomes rather than age.
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Affiliation(s)
- Nikolaos Charalampakis
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Lianchun Xiao
- Department of Biostatistics, The University of Texas M.D. Anderson Cancer, Houston, TX, USA
| | - Quan Lin
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Elena Elimova
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Yusuke Shimodaira
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Kazuto Harada
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Jane E Rogers
- Department of Pharmacy Clinical Programs, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jeannette Mares
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Fatemeh G Amlashi
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Aurelio Matamoros
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Tara L Sagebiel
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Mariela A Blum-Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA
| | - Jeffrey H Lee
- Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Brian Weston
- Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA
| | - Paul F Mansfield
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jeannelyn S Estrella
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
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Mikami K, Hirano K, Futami K, Maekawa T. Gastrectomy with limited surgery for elderly patients with gastric cancer. Asian J Surg 2016; 41:65-72. [PMID: 27693065 DOI: 10.1016/j.asjsur.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 08/18/2016] [Accepted: 09/02/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND/OBJECTIVE Elderly patients with gastric cancer can receive standard gastrectomy or gastrectomy with reduced nodal dissection, i.e., limited surgery, in order to prevent postoperative complications. This study evaluated the feasibility of gastrectomy with limited surgery for elderly patients with gastric cancer. METHODS A total of 267 elderly patients (≥70 years old) were divided into two groups according to the level of nodal dissection: patients who received nodal dissection according to guidelines were included in the standard surgery group (standard group), and those who received reduced nodal dissection were included in the limited surgery group (limited group). The surgical outcomes of the two groups were compared. RESULTS There were 170 patients in the standard group and 97 patients in the limited group. The limited group had significantly poorer nutrition status and a significantly higher proportion with comorbidities. Morbidity and mortality were similar in both groups. Multivariate analysis showed that the overall survival rates were significantly worse in patients with advanced age, male gender, low body mass index, low prognostic nutrition index, and higher tumor stage. The disease-specific survival rate was significantly lower in the limited group than in the standard group (p<0.001). CONCLUSION Gastrectomy according to the gastric treatment guidelines for elderly patients with gastric cancer is recommended. Elderly male patients with poor nutrition have poor prognosis; prognostic nutrition index <40. Limited surgery is a treatment option for such patients.
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Affiliation(s)
- Koji Mikami
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan.
| | - Kimikazu Hirano
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan
| | - Kitarou Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan
| | - Takafumi Maekawa
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan
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Solaini L, Ministrini S, Coniglio A, Cavallari S, Molteni B, Baiocchi GL, Portolani N, Tiberio GAM. How could we identify the 'old' patient in gastric cancer surgery? A single centre cohort study. Int J Surg 2016; 34:174-179. [PMID: 27613126 DOI: 10.1016/j.ijsu.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze the population submitted to gastric cancer surgery in our Institution in order to find those characteristics which could help in the identification of the elderly high-risk patient. METHODS In a cohort of 263 patients (>65 y) we selectively investigated the risk factors for medical and surgical complications and postoperative mortality, focusing on the variable "age". All the significant variables were used to find predictors of complications with Clavien-Dindo>2. RESULTS Age>75 (AUC 0.61; 95% 0.55-0.67, p = 0.003) and ASA score >2 (AUC 0.60; 95% CI 0.54-0.67, p = 0.01) were significantly associated with an increased risk of medical complications. Operative time >330 min (OR 1.00; 95% CI 1.00-1.01; p = 0.0001- AUC 0.62, 95% CI 0.56-0.68, p = 0.01) was the only significant predictor of surgical complications. In-hospital mortality (6/263 patients) was significantly associated with preoperative albumin ≤2.95 g/dl (OR 0.15; 95% CI 0.04-0.93, p = 0.041 - AUC 0.74 95% CI 0.68-0.80; p = 0.003) and additional procedures (OR 7.05; 1.23-40.32, p = 0.03). Stepwise multivariate analysis showed that albumin ≤2.95 g/dl (OR 3.43; 95% CI 1.06-11.13 p = 0.033), ASA>2 (OR 9.51; 95% CI 1.23-72.97; p = 0.042) and additional resections (OR 3.39; 95% CI 1.36-8.45; p = 0.045) were independent risk factors for complications Clavien Dindo >2. CONCLUSIONS Our work demonstrated that, in our institution, 75 years of age could identify the elderly in gastric surgery as those patients were at higher risk of medical complications. ASA >2, preoperative serum albumin ≤2.95 g/dl and the need of additional procedures could increase the risk of severe postoperative adverse events.
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Affiliation(s)
- Leonardo Solaini
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy.
| | - Silvia Ministrini
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Arianna Coniglio
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Sara Cavallari
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Beatrice Molteni
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Gian Luca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Nazario Portolani
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
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Schlesinger-Raab A, Mihaljevic AL, Egert S, Emeny R, Jauch KW, Kleeff J, Novotny A, Nüssler NC, Rottmann M, Schepp W, Schmitt W, Schubert-Fritschle G, Weber B, Schuhmacher C, Engel J. Outcome of gastric cancer in the elderly: a population-based evaluation of the Munich Cancer Registry. Gastric Cancer 2016; 19:713-22. [PMID: 26260874 DOI: 10.1007/s10120-015-0527-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/23/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric cancer accounts for 5 % of cancer deaths. Proportions of older stomach cancer patients are increasing. Despite the still poor prognosis, standardised treatment has achieved improvements; nonetheless it is questionable whether all age groups have benefitted. Age and outcome need to be examined in a population-based setting. METHODS Analyses included Munich Cancer Registry (MCR) data from 8601 invasive gastric cancer patients, diagnosed between 1998 and 2012. Tumour and therapy characteristics and outcome were analysed by two age groups (<70 vs. ≥70 years). Survival was analysed using the Kaplan-Meier method and relative survival was computed as an estimation for cancer-specific survival. Additional landmark analyses were conducted by calculating conditional survival of patients who survived more than 6 months. RESULTS Fifty-nine per cent of the cohort were ≥70 years old. These patients had tumours with a slightly better prognosis and were treated with less radical surgery and adjuvant therapy than younger patients. The 5-year relative survival was 40 % for the youngest (<50 years) and 23 % for the oldest patients (≥80 years). Survival differences were diminished or eliminated after landmark analyses: The 5-year relative survival in age groups 50-59, 60-69 and 70-79 years was comparable (between 48 and 49.6 %) and slightly worse in the youngest and oldest (45 %), which may be explained by more aggressive tumours and effects of cellular senescence, respectively. CONCLUSION The treatment and care of elderly gastric cancer patients in the MCR catchment area seems appropriate: if a patient's general condition allows oncologic resection and chemotherapy, it is conducted and the result is comparable between age groups.
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Affiliation(s)
- Anne Schlesinger-Raab
- Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - André L Mihaljevic
- Department of Surgery, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany
| | - Silvia Egert
- Münchner Studienzentrum (MSZ), Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Rebecca Emeny
- Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Karl-Walter Jauch
- Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jörg Kleeff
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Natascha C Nüssler
- Department of Surgery, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany
| | - Miriam Rottmann
- Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Schepp
- Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Klinikum Bogenhausen, Städtisches Klinikum München, Munich, Germany
| | - Wolfgang Schmitt
- Department of Gastroenterology, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany
| | - Gabriele Schubert-Fritschle
- Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany
| | - Bernhard Weber
- Department of Internal Medicine, Klinik Bad Trissl, Oberaudorf, Germany
| | | | - Jutta Engel
- Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany
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18
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Sohn IW, Jung DH, Kim JH, Chung HS, Park JC, Shin SK, Lee SK, Lee YC. Analysis of the Clinicopathological Characteristics of Gastric Cancer in Extremely Old Patients. Cancer Res Treat 2016; 49:204-212. [PMID: 27384160 PMCID: PMC5266408 DOI: 10.4143/crt.2016.163] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/07/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Gastric cancer is the third-leading cause of cancer-related death in Korea. As the Korean population is ageing, the number of extremely old patients with this disease is increasing. This study examined the clinicopathological characteristics of gastric cancer in extremely old (over 85 years) patients who received treatment or conservative observations and compared the treatment outcomes according to the treatment modality. MATERIALS AND METHODS A total of 170 patients over 85 years of age were diagnosed with gastric cancer. Of these, 81 underwent treatment for gastric cancer and 89 received conservative observations. The clinicopathological characteristics of the treatment and conservative groupswere compared. RESULTS The mean age of the patients was 86.5 years. The conservative group included significantly more patients with older ages, macroscopically advanced cancer and upper-middle located cancer. The overall survival rate of the treatment group was significantly higher than that of the conservative group. The disease-specific mortality rate was significantly lower in the treatment group than in the conservative group. Multivariate analysis revealed the clinical course, alarm sign, and macroscopic classification to be independent prognosis factors. CONCLUSION By itself, the chronological age should not be used as a strategy to determine whether treatmentwill be administered for gastric cancer. Patients who have early gastric cancer or lower-risk preexisting comorbidities should not be discouraged from treatment, even if they are older than 85 years.
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Affiliation(s)
- Il Woong Sohn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Da Hyun Jung
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Soo Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Tran TB, Worhunsky DJ, Squires MH, Jin LX, Spolverato G, Votanopoulos KI, Schmidt C, Weber S, Bloomston M, Cho CS, Levine EA, Fields RC, Pawlik TM, Maithel SK, Norton JA, Poultsides GA. Outcomes of Gastric Cancer Resection in Octogenarians: A Multi-institutional Study of the U.S. Gastric Cancer Collaborative. Ann Surg Oncol 2015; 22:4371-9. [DOI: 10.1245/s10434-015-4530-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Indexed: 02/06/2023]
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Wyld L, Audisio RA, Poston GJ. The evolution of cancer surgery and future perspectives. Nat Rev Clin Oncol 2014; 12:115-24. [PMID: 25384943 DOI: 10.1038/nrclinonc.2014.191] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Surgery is the oldest oncological discipline, dating back thousands of years. Prior to the advent of anaesthesia and antisepsis 150 years ago, only the brave, desperate, or ill-advised patient underwent surgery because cure rates were low, and morbidity and mortality high. However, since then, cancer surgery has flourished, driven by relentless technical innovation and research. Historically, the mantra of the cancer surgeon was that increasingly radical surgery would enhance cure rates. The past 50 years have seen a paradigm shift, with the realization that multimodal therapy, technological advances, and minimally invasive techniques can reduce the need for, or the detrimental effects of, radical surgery. Preservation of form, function, and quality of life, without compromising survival, is the new mantra. Today's surgeons, no longer the uneducated technicians of history, are highly trained medical professionals and together with oncologists, radiologists, scientists, anaesthetists and nurses, have made cancer surgeries routine, safe, and highly effective. This article will review the major advances that have underpinned this evolution.
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Affiliation(s)
- Lynda Wyld
- Department of Oncology, Royal Hallamshire Hospital, University of Sheffield, Glossop Road, Sheffield S10 2RX, UK
| | - Riccardo A Audisio
- Department of Surgery, St Helens Teaching Hospital, University of Liverpool, St Helens, Merseyside WA9 3DA, UK
| | - Graeme J Poston
- Department of Surgery, Aintree University Hospital, Longmoor Lane, Liverpool, Merseyside L9 7AL, UK
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Shin HS, Oh SJ, Suh BJ. Factors related to morbidity in elderly gastric cancer patients undergoing gastrectomies. J Gastric Cancer 2014; 14:173-9. [PMID: 25328762 PMCID: PMC4199884 DOI: 10.5230/jgc.2014.14.3.173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 01/19/2023] Open
Abstract
Purpose The prevalence of gastric cancer in the elderly is increasing. The purpose of this study was to clarify factors related to morbidity following gastric cancer surgery in elderly patients. Materials and Methods For this study, data from 411 patients who underwent curative gastrectomies with lymph node dissections between March 2010 and January 2013 were retrospectively studied using a prospectively designed database. Patients were divided into 2 groups (<70 years vs. ≥70 years). For each group, perioperative factors were analyzed to determine if they were associated with postoperative morbidity and mortality. Results Comorbidities were more prevalent in the elderly group (≥70 years). Intraoperative and postoperative transfusions were also more frequently required in the elderly group. There was no significant difference in the number of retrieved lymph nodes between the 2 groups (44.3 vs. 46.6 nodes). In a comparison of the elderly versus non-elderly groups, the postoperative morbidity rates were 22.7% versus 8.9% (P<0.001) and the postoperative mortality rates were 4.2% versus 0% (P=0.002), respectively. Of the possible non-surgical complications, pulmonary problems were predominately found in the elderly group (P<0.001). Surgical complications were evenly distributed between the 2 groups (P=0.463). Postoperative morbidity was significantly associated with older age and postoperative transfusion. Multivariate analysis showed that higher body mass index (BMI) and postoperative transfusion were important factors associated with postoperative complications in the elderly group. Conclusions Pulmonary complications were frequently problematic in elderly patients. Higher BMI and postoperative transfusion were significant risk factors for postoperative complications in elderly patients with gastric cancer.
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Affiliation(s)
- Ha Song Shin
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Byoung Jo Suh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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He MM, Zhang DS, Wang F, Wang ZQ, Luo HY, Jin Y, Wei XL, Xu RH. The role of non-curative surgery in incurable, asymptomatic advanced gastric cancer. PLoS One 2013; 8:e83921. [PMID: 24358318 PMCID: PMC3865283 DOI: 10.1371/journal.pone.0083921] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/11/2013] [Indexed: 12/22/2022] Open
Abstract
Background Although general agreement exists on palliative surgery with intent of symptom palliation in advanced gastric cancer (AGC), the role of non-curative surgery for incurable, asymptomatic AGC is hotly debated. We aim to clarify the role of non-curative surgery in patients with incurable, asymptomatic AGC under the first-line chemotherapy. Methods A total of 737 patients with incurable, asymptomatic advanced gastric adenocarcinoma between January 2008 and May 2012 at the Sun Yat-sen University Cancer Center were retrospectively analyzed, comprising 414 patients with non-curative surgery plus first-line chemotherapy, and 323 patients with first-line chemotherapy only. The clinicopathologic data, survival, and prognosis were evaluated, with propensity score adjustment for selection bias. Results The median overall survival (OS) outcomes significantly favored non-curative surgery group over first-line chemotherapy only group in entire population (28.00 versus 10.37 months, P = 0.000), stage 4 patients (23.87 versus 10.37 months, P = 0.000), young patients (28.70 versus 10.37 months, P = 0.000) and elderly patients (23.07 versus 10.27 months, P = 0.031). The median OS advantages of non-curative surgery over first-line chemotherapy only were also maintained when the analyses were restricted to single organ metastasis (P = 0.001), distant lymph node metastasis (P = 0.002), peritoneal metastasis (P = 0.000), and multi-organ metastasis (P = 0.010). Significant OS advantages of non-curative surgery over chemotherapy only were confirmed solid by multivariate analyses before and after adjustment on propensity score (P = 0.000). Small subsets of patients with surgery of single metastatic lesion after previous curative gastrectomy, and with surgery of both primary and single metastatic sites showed sound median OS. Conclusions There is a role for non-curative surgery plus first-line chemotherapy for incurable, asymptomatic AGC, in terms of survival. Randomized controlled trials are warranted to fill a gap in knowledge about the value of metastectomy and patient selection strategies.
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Affiliation(s)
- Ming-ming He
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dong-sheng Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Feng Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-qiang Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui-yan Luo
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ying Jin
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-li Wei
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui-hua Xu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- * E-mail:
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Liang YX, Deng JY, Guo HH, Ding XW, Wang XN, Wang BG, Zhang L, Liang H. Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years. World J Gastroenterol 2013; 19:6568-6578. [PMID: 24151383 PMCID: PMC3801370 DOI: 10.3748/wjg.v19.i39.6568] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/28/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.
METHODS: We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003 and December 2007 in our center. Patients were categorized into three groups: younger group (age < 50 years), middle-aged group (50-69 years), and elderly group (≥ 70 years). Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed. The log-rank test was used to assess statistical differences between curves. Independent prognostic factors were identified by the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of age on survival at each stage. Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer. We analyzed the potential prognostic factors for patients aged ≥ 70 years. Finally, the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated.
RESULTS: In the elderly group, there was a male predominance. At the same time, cancers of the upper third of the stomach, differentiated type, and less-invasive surgery were more common than in the younger or middle-aged groups. Elderly patients were more likely to have advanced tumor-node-metastasis (TNM) stage and larger tumors, but less likely to have distant metastasis. Although 5-year overall survival (OS) rate specific to gastric cancer was not significantly different among the three groups, elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients (elderly vs middle-aged vs younger patients = 22.0% vs 36.6% vs 38.0%, respectively). In the TNM-stratified analysis, the differences in OS were only observed in patients with II and III tumors. In multivariate analysis, only surgical margin status, pT4, lymph node metastasis, M1 and sex were independent prognostic factors for elderly patients. The 5-year OS rate did not differ between elderly patients undergoing D1 and D2 lymph node resection, and these patients benefited little from chemotherapy.
CONCLUSION: Age ≥ 70 years was an independent prognostic factor for gastric cancer after gastrectomy. D1 resection is appropriate and postoperative chemotherapy is possibly unnecessary for elderly patients with gastric cancer.
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Yamada H, Shinohara T, Takeshita M, Umesaki T, Fujimori Y, Yamagishi K. Postoperative complications in the oldest old gastric cancer patients. Int J Surg 2013; 11:467-71. [PMID: 23602896 DOI: 10.1016/j.ijsu.2013.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 04/10/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND With the aging of the population, the number of elderly patients with gastric cancer is anticipated to increase. This study evaluated the feasibility of gastrectomy for patients over 85 years old. METHODS A total of 176 patients who underwent gastrectomy for gastric cancer were assigned into two groups: 75-84 years group (n = 152); and ≥85 years group (n = 24). Preoperative comorbidities, operative results, and postoperative outcomes were retrospectively analyzed. RESULTS In terms of concurrent illness, no significant differences were observed between groups. Preoperative lymphocyte (Lym) count, hemoglobin (Hb) level and serum albumin (Alb) levels were significantly lower in the ≥85 years group than in the 75-84 years group (Lym: 11.0 ± 2.2 × 10²/mm³ vs. 14.9 ± 3.2 × 10²/mm³, P = 0.0009; Hb: 11.2 ± 2.3 mg/dl vs. 12.4 ± 1.5 mg/dl, P = 0.038; Alb: 3.5 ± 0.5 mg/dl vs. 4.1 ± 0.3 mg/dl, P = 0.0006, respectively). Percent vital capacity was likewise lower in the ≥85 years group than in the 75-84 years group (86.2 ± 11.4% vs. 96.1 ± 12.2%, P = 0.04). Percentage forced expiratory volume in 1 s showed no significant difference. Incidence of postoperative pneumonia was higher in the ≥85 years group than in the 75-84 years group (P = 0.006). Time to first flatus and postoperative hospital stay were similar in both groups. CONCLUSION Patients over 85 years old are more likely to suffer postoperative pneumonia after gastrectomy than younger old patients. Preoperative risk assessment is essential for the oldest old patients.
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Affiliation(s)
- Hiroyuki Yamada
- Department of Surgery, Hokushin General Hospital, 1-5-63 Nishi, Nakano-shi, Nagano 383-8505, Japan.
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Biondi A, Cananzi FC, Persiani R, Papa V, Degiuli M, Doglietto GB, D'Ugo D. The Road to Curative Surgery in Gastric Cancer Treatment: A Different Path in the Elderly? J Am Coll Surg 2012; 215:858-67. [DOI: 10.1016/j.jamcollsurg.2012.08.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/22/2012] [Accepted: 08/22/2012] [Indexed: 11/29/2022]
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Pata G, Solaini L, Roncali S, Pasini M, Ragni F. Total gastrectomy with “over-D1” lymph node dissection: what is the actual impact of age? Am J Surg 2012; 204:732-40. [PMID: 22633445 DOI: 10.1016/j.amjsurg.2012.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 02/27/2012] [Accepted: 02/27/2012] [Indexed: 01/01/2023]
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Abstract
BACKGROUND Owing to the increased life expectancy, elderly patients with gastric cancer is also increasing. Onodera's prognostic nutritional index (PNI) is an assessment tool for nutritional status of surgical patients and possibly predicts prognosis of the patients. The aim of the present study is to clarify the predictive and prognostic significance of PNI in elderly patients who underwent gastrectomy for gastric cancer. METHODS Two hundred ninety-five patients, including 196 nonelderly patients under 75 years old (group NE) and 99 elderly patients (group E), were eligible. We collected the data on nutritional status and the outcome of gastrectomy, including morbidity, mortality, and survival of these patients. A Cox proportional hazards model was used to evaluate the prognostic significance. RESULTS The PNI was significantly lower in group E than in group NE. Both morbidity and mortality rates after gastrectomy were similar between the groups. Although PNI could not predict the postoperative events in group NE, low PNI might be a risk of mortality and morbidity in the elderly. Although survival after gastrectomy was similar among groups divided by the median PNI value (49.2) in group NE, the prognosis of PNI-L (<44.7) was significantly poorer than PNI-H (PNI ≧ 44.7) in group E. Multivariate analysis demonstrated that PNI-L was an independent prognostic factor in the elderly. CONCLUSIONS The PNI predicts both short-term and long-term outcomes after gastrectomy in the elderly.
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Shim JH, Ko KJ, Yoo HM, Oh SI, Jeon DJ, Jeon HM, Park CH, Song KY. Morbidity and mortality after non-curative gastrectomy for gastric cancer in elderly patients. J Surg Oncol 2012; 106:753-6. [PMID: 22495554 DOI: 10.1002/jso.23121] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/23/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES This study examined the surgical outcome of non-curative resection in elderly patients with gastric cancer. METHODS The study reviewed 278 patients who underwent non-curative resection for advanced gastric cancer. The clinicopathological features of elderly patients (≥ 75 years, n = 257) and younger patients (<75 years, n = 21) were compared. RESULTS Although no difference was observed in terms of preoperative performance, there were distinct differences in terms of albumin level, presence of symptoms, and the rate of comorbidities between the two groups. The postoperative morbidity and mortality rate did not differ between the two groups. Age, preoperative performance status, preoperative transfusion, and presence of comorbidity were not independent predictors of postoperative complications. However, the extent of gastric resection and combined resection were closely related to postoperative complications in patients with non-curative gastrectomy. CONCLUSIONS In a setting of non-curative resection for gastric cancer, age was not a limiting factor. Rather, the risk of postoperative morbidity should be considered carefully in total gastrectomy and combined resection.
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Affiliation(s)
- Jung Ho Shim
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Standard radical gastrectomy in octogenarians and nonagenarians with gastric cancer: are short-term surgical results and long-term survival substantial? J Gastrointest Surg 2012; 16:728-37. [PMID: 22350724 DOI: 10.1007/s11605-012-1835-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 02/02/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The high incidence of gastric cancer among the octogenarians and nonagenarians (oldest old; age ≥ 80 years) is emerging as an important management issue. Herein, we report both the short-term outcomes and long-term survival results of standard radical gastrectomy in this group of patients. METHODS This was a retrospective review of 164 oldest old patients (older group) and 2,258 younger patients (age <80 years; younger group) with gastric cancer who underwent curative resection between January 1994 and December 2006. Clinicopathologic data, long-term survival, and prognostic factors were analyzed. RESULTS Clinical tumor stage did not differ between the two groups at the time of diagnosis. Higher Charlson comorbidity index scores (≥ 5) were observed in the older group than in the younger group; this was associated with higher postoperative morbidity (P = 0.035) and in-hospital mortality rates (P = 0.015) in the older group. At a median follow-up of 37.8 months, the overall survival rate for the older group was lower than that for the younger group (P < 0.001). However, the cumulative incidence of gastric cancer-related deaths was comparable between the two groups. Nodal involvement and metastatic to retrieved lymph node ratio were the only independent predictors of survival in the older group. CONCLUSIONS Patients in the older group had a higher postoperative morbidity rate but comparable cancer-specific survival. Careful patient selection for gastrectomy is warranted in elderly patients, particularly those with high-grade nodal involvement.
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Lee SR, Kim HO, Yoo CH. Impact of chronologic age in the elderly with gastric cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:211-8. [PMID: 22493761 PMCID: PMC3319774 DOI: 10.4174/jkss.2012.82.4.211] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/07/2012] [Accepted: 02/20/2012] [Indexed: 12/13/2022]
Abstract
Purpose Although the incidence of gastric cancer has declined in the general population, it is the second most frequent cause of death due to malignancy in the world with its incidence in the elderly increasing as a result of increased life expectancy. This present study tried to find the optimal treatment for patients aged 75 years or older with gastric cancer through comparison of the clinicopathological characteristics, surgical outcomes, and identifying prognostic factors of survival. Methods Elderly patients who underwent gastric resection for gastric cancer from January, 1999 to February, 2009 (n = 470) were divided into two groups: very elderly patients, 75 years or older (n = 95), and younger elderly patients, between 65 and 74 years old (n = 365). Results Distinct characteristics of very elderly patients included more frequent underlying disease, deeper invasion, and more frequent lymph node metastasis. There were significant differences in overall survival between the two groups at stages III-B and IV. However, postoperative hospital stays, postoperative morbidity, mortality and early stage did not differ between curatively resected patients in the two groups. Conclusion Due to improved postoperative care, gastrectomy of gastric cancer is the treatment of choice in very elderly patients. Therefore, early diagnosis through regular medical screening and curative gastrectomy with lymph node dissection should be performed in very elderly gastric cancer patients.
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Affiliation(s)
- Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Impact of Clinical and Pathohistological Characteristics on the Incidence of Recurrence and Survival in Elderly Patients with Gastric Cancer. World J Surg 2011; 36:338-45. [DOI: 10.1007/s00268-011-1395-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Elderly patients constitute the largest group in oncologic medical practice, despite the fact that in solid cancers treated operatively, many patients are denied standard therapies and where such decision making is based solely on age. The “natural” assumptions that we have are often misleading; namely, that the elderly cannot tolerate complex or difficult procedures, chemotherapy, or radiation schedules; that their overall predictable medical health determines survival (and not the malignancy); or that older patients typically have less aggressive tumors. Clearly, patient selection and a comprehensive geriatric assessment is key where well-selected cases have the same cancer-specific survival as younger cohorts in a range of tumors as outlined including upper and lower gastrointestinal malignancy, head and neck cancer, and breast cancer. The assessment of patient fitness for surgery and adjuvant therapies is therefore critical to outcomes, where studies have clearly shown that fit older patients experience the same benefits and toxicities of chemotherapy as do younger patients and that when normalized for preexisting medical conditions,that older patients tolerate major operative procedures designed with curative oncological intent. At present, our problem is the lack of true evidence-based medicine specifically designed with age in mind, which effectively limits surgical decision making in disease-based strategies. This can only be achieved by the utilization of more standardized, comprehensive geriatric assessments to identify vulnerable older patients, aggressive pre-habilitation with amelioration of vulnerability causation, improvement of patient-centered longitudinal outcomes, and an improved surgical and medical understanding of relatively subtle decreases in organ functioning, social support mechanisms and impairments of health-related quality of life as a feature specifically of advanced age.
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Affiliation(s)
- Andrew P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Tel-Aviv, Israel 52621.
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Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 2011; 254:375-82. [PMID: 21772131 DOI: 10.1097/sla.0b013e318226a959] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify the mortality risk factors of elderly patients (≥65 years old) during major digestive surgery, as defined according to the complexity of the operation. BACKGROUND In the aging populations of developed countries, the incidence rate of major digestive surgery is currently on the rise and is associated with a high mortality rate. Consequently, validated indicators must be developed to improve elderly patients' surgical care and outcomes. METHODS We acquired data from a multicenter prospective cohort that included 3322 consecutive patients undergoing major digestive surgery across 47 different facilities. We assessed 27 pre-, intra-, and postoperative demographic and clinical variables. A multivariate analysis was used to identify the independent risk factors of mortality in elderly patients (n = 1796). Young patients were used as a control group, and the end-point was defined as 30-day postoperative mortality. RESULTS In the entire cohort, postoperative mortality increased significantly among patients aged 65-74 years, and an age ≥65 years was by itself an independent risk factor for mortality (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.36-3.59; P = 0.001). The mortality rate among elderly patients was 10.6%. Six independent risk factors of mortality were characteristic of the elderly patients: age ≥85 years (OR, 2.62; 95% CI, 1.08-6.31; P = 0.032), emergency (OR, 3.42; 95% CI, 1.67-6.99; P = 0.001), anemia (OR, 1.80; 95% CI, 1.02-3.17; P = 0.041), white cell count > 10,000/mm³ (OR, 1.90; 95% CI, 1.08-3.35; P = 0.024), ASA class IV (OR, 9.86; 95% CI, 1.77-54.7; P = 0.009) and a palliative cancer operation (OR, 4.03; 95% CI, 1.99-8.19; P < 0.001). CONCLUSION Characterization of independent validated risk indicators for mortality in elderly patients undergoing major digestive surgery is essential and may lead to an efficient specific workup, which constitutes a necessary step to developing a dedicated score for elderly patients.
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Aparicio T, Wind P, des Guetz G, Tidjani L, Dulou L. Prise en charge des carcinomes oesogastriques, pancréatiques et hépatocellulaires du sujet âgé. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-1987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gaskell S, Kristjansson SR, Audisio RA. Principles of surgical oncology in older adults. PRACTICAL GERIATRIC ONCOLOGY 2010:52-62. [DOI: 10.1017/cbo9780511763182.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Abstract
BACKGROUND Palliative resection for noncurable gastric cancer remains controversial, especially in the elderly. This retrospective study was designed to elucidate the clinicopathological factors and operative outcome in patients undergoing palliative gastric resection. METHODS From January 1988 to December 2008, 365 patients received palliative gastrectomy while 151 underwent exploratory laparotomy or gastrojejunostomy for noncurative gastric cancer at the Department of Surgery, Taipei Veterans General Hospital. Among the 365 patients, 182 patients (Group A) were aged 70 or less and 183 patients (Group B) were older than 70 years of age. Clinicopathological characteristics and surgical morbidity and mortality were analyzed. RESULTS The overall survival of patients who underwent resection was 10.2 months and that of patients without resection 4.48 months (p < 0.001). Compared to Group B, Group A patients were predominantly female (p < 0.001), had more advanced Borrmann-type tumors (p = 0.004), more diffuse type of Lauren classification (p < 0.001), and poorer cell differentiation (p < 0.001). The median overall survival was 10.5 months in Group A and 9.7 months in Group B (p = 0.854). The surgical morbidity was significant higher if the patients had comorbidity (p = 0.028). Both surgical morbidity (13.8% vs. 26.8%, p = 0.028) and mortality (0.5% vs. 6.0%, p < 0.0001) were significantly higher in Group B. CONCLUSIONS Gastric cancer is less aggressive in the elderly. Palliative gastrectomy can be performed in both younger and older patients, but younger patients tolerate surgery better. More attention should be paid to the perioperative care of the elderly.
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Saif MW, Makrilia N, Zalonis A, Merikas M, Syrigos K. Gastric cancer in the elderly: an overview. Eur J Surg Oncol 2010; 36:709-17. [PMID: 20542657 DOI: 10.1016/j.ejso.2010.05.023] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2009] [Revised: 01/27/2010] [Accepted: 05/17/2010] [Indexed: 12/13/2022] Open
Abstract
AIMS Gastric cancer in the elderly represents a distinct entity with specific clinicopathological characteristics and the majority of affected patients belong to this age group. Subtotal or total gastrectomy with radical lymph node dissection, adjuvant chemoradiotherapy or perioperative chemotherapy represent the only potentially curative treatment options and seem to be performed with acceptable morbidity and mortality rates in selected elderly patients. Published research is very limited due to the strict selection and under-representation of elderly patients in clinical trials. A review of current recommendations and practice was performed. METHODS A comprehensive literature review was performed searching Medline for articles published since 1974, using "gastric cancer", "elderly" and "treatment" as keywords. OBSERVATIONS The data suggest that elderly patients that fulfill the inclusion criteria of clinical trials experience the same advantages and toxicities from chemotherapy as younger patients. Fit elderly patients with operable gastric cancer should be candidates for the standard surgical resection provided that preoperative comorbidities are taken into account. Perioperative chemotherapy or postoperative chemoradiotherapy should be added in case of locally advanced disease. Palliative systemic chemotherapy seems to prolong survival in recurrent and metastatic disease. CONCLUSIONS Chronological age alone is not sufficient reason to withhold curative or palliative treatment from an elderly gastric cancer patient. Performance status does not suffice in order to estimate the general condition of elderly patients and cofactors regarding their functional, social and mental status have to be considered.
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Affiliation(s)
- M W Saif
- Department of Clinical Oncology, Yale University School of Medicine New Haven, CT, USA
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Short-and long-term outcomes of surgery for diffuse peritonitis in patients 80 years of age and older. Surg Today 2008; 38:413-9. [DOI: 10.1007/s00595-007-3658-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 08/20/2007] [Indexed: 11/27/2022]
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Kunisaki C, Makino H, Takagawa R, Oshima T, Nagano Y, Ono HA, Akiyama H, Shimada H. Efficacy of laparoscopy-assisted distal gastrectomy for gastric cancer in the elderly. Surg Endosc 2008; 23:377-83. [PMID: 18443861 DOI: 10.1007/s00464-008-9949-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2008] [Accepted: 04/05/2008] [Indexed: 12/20/2022]
Abstract
BACKGROUND To date, it has been unclear whether laparoscopy-assisted distal gastrectomy (LADG) is a suitable treatment for elderly patients with early gastric cancer. This study retrospectively compared surgical outcomes between elderly and nonelderly patients with gastric cancer. METHODS The study group was comprised of 211 patients who underwent distal gastrectomy between April 2000 and March 2007. Of these, 130 patients (26 aged >or=75 years and 104 aged <75 years) underwent LADG, and the remaining 81 patients underwent conventional open distal gastrectomy (ODG). Short- and long-term patient outcomes were evaluated. RESULTS The operation time was significantly longer in the LADG group than in the ODG group (262.6 versus 234.3 min, p = 0.005), but the other short-term outcomes did not differ between the two groups. When performed by an experienced surgeon, blood loss was significantly reduced, while operation time for LADG was similar to that for ODG. Within the LADG group, incidences of comorbid disease and lymph-node metastasis were significantly greater, the histological tumor type was significantly more differentiated, and the macroscopically depressed tumor type was less common in elderly patients. However, the incidence of postoperative morbidity did not differ between the elderly and nonelderly groups (11.5% versus 3.8%, p = 0.1201), and there was no significant difference in postoperative course. Logistic regression analysis showed that body mass index, but not chronological age, was an independent predictive factor of postoperative morbidity (odds ratio = 3.674, p = 0.045). There were no significant differences in overall or disease-specific survival between elderly and nonelderly patients. CONCLUSION LADG is an effective treatment for elderly patients with early gastric cancer if it is performed by an experienced surgeon. A high-volume study is needed to confirm this rationale.
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Affiliation(s)
- Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
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Kakushima N, Fujishiro M, Kodashima S, Muraki Y, Tateishi A, Yahagi N, Omata M. Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population. J Gastroenterol Hepatol 2007; 22:311-4. [PMID: 17295759 DOI: 10.1111/j.1440-1746.2006.04563.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) is gaining acceptance among endoscopists for its efficacy, especially in Japan. Elderly patients often have operative risk due to comorbid diseases, and the feasibility of this treatment for such patients should be investigated. The aim of this study is to evaluate the efficacy and safety of ESD in elderly patients. METHODS Among 308 gastric neoplasms treated by ESD from 2000 to 2004 in one hospital, 49 lesions were discovered in 42 elderly patients who were 75 years of age or older. Indication criteria for ESD were gastric neoplasms with no apparent massive submucosal invasion diagnosed by endoscopy. The en bloc plus R0 resection rate and complications were assessed in comparison with younger patients. RESULTS The average age of the patients was 78.9 years (range 75-88 years). Of these patients, 24 (57%) had comorbid diseases. The complete en bloc plus R0 resection rate was 96% (47/49). Postoperative bleeding requiring emergency endoscopy occurred in three patients (7%). Perforation during ESD occurred in one patient (2%), and was immediately closed with endoclips and managed by conservative medical treatment. The en bloc plus R0 resection rate and complication rate in elderly patients were not significantly different from those of younger patients. CONCLUSIONS These results indicate that ESD could be a safe and reliable treatment for gastric neoplasms in elderly patients.
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Affiliation(s)
- Naomi Kakushima
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
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Gretschel S, Estevez-Schwarz L, Hünerbein M, Schneider U, Schlag PM. Gastric cancer surgery in elderly patients. World J Surg 2006; 30:1468-74. [PMID: 16850149 DOI: 10.1007/s00268-005-0633-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Stephen Gretschel
- Department of Surgery and Surgical Oncology, Charité, University Medicine Berlin, Campus Buch, Robert-Rössle-Cancer Hospital, HELIOS Klinikum, Berlin, Germany
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Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono HA, Shimada H. Comparison of surgical outcomes of gastric cancer in elderly and middle-aged patients. Am J Surg 2006; 191:216-24. [PMID: 16442949 DOI: 10.1016/j.amjsurg.2005.09.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2005] [Revised: 09/13/2005] [Accepted: 09/13/2005] [Indexed: 12/13/2022]
Abstract
BACKGROUND We compared clinicopathological features and results of surgery for gastric carcinoma in elderly and middle-aged patients to develop appropriate treatment for elderly patients with gastric carcinoma. METHODS Surgical results were assessed for 135 elderly patients (over 75 years old) and 665 middle-aged patients (between 45 and 65 years old) with gastric cancer. RESULTS Distinct characteristics of elderly patients were male predominance; macroscopically well, or ill-defined, histologically differentiated tumors; and advanced stage disease. There was a significant difference in overall survival between the groups for early stage carcinomas but no difference in cause-specific survival. Postoperative morbidities did not differ between the curatively resected patients in the 2 groups. Moreover, deaths from other cancers or comorbid disease were frequent among the elderly. CONCLUSION Meticulous treatment and follow-up not only for gastric carcinoma but also for other diseases would improve survival in elderly patients, particularly those with early-stage tumors.
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Affiliation(s)
- Chikara Kunisaki
- Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
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Di Martino N, Izzo G, Cosenza A, Cerullo G, Torelli F, Brillantino A, del Genio A. Adenocarcinoma of gastric cardia in the elderly: Surgical problems and prognostic factors. World J Gastroenterol 2005; 11:5123-8. [PMID: 16127740 PMCID: PMC4320383 DOI: 10.3748/wjg.v11.i33.5123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze retrospectively, our results about patients who underwent surgical treatment for adenocarcinoma of the cardia in relation to age, in order to evaluate surgical problems and prognostic factors.
METHODS: From January 1987 to March 2003, 140 patients with adenocarcinoma of the cardia underwent resection in the authors’ institution. They were divided into three groups with regard to age. Patients <70 and >60 year old (31) were excluded; we also excluded 18 out of 109 patients with poor general status or systemic metastases. So, we compared 51 elderly (≥ 70 year old) and 58 younger patients (≤ 60 year old). The treatment was esophagectomy for type I tumors, and extended gastrectomy and distal esophagectomy for type II and III lesions.
RESULTS: Laparotomy was carried out in 91 patients (83.4%), 38 in the elderly (74.5%) and 53 in younger patients (91.3%, P<0.05). Primary resection was performed in 81 cases (89%) without significant differences between the two groups. Postoperative death was higher in the elderly (12.1%) than the other group (4.1%, P<0.05), while morbidity was similar in both groups. A curative resection (R0) was performed in 59 patients (72.8%), 69.6% in the elderly and 75% in the younger group (P>0.05). The overall 3- and 5-year survival rates were 26.7% and 17.8% respectively for the elderly and 40.7% and 35.1% respectively for younger patients (P = 0.1544). Survival rates were significantly associated with R0 resection, pathological node-positive category and tumor differentiation in both groups.
CONCLUSION: As the age of the general population increases, more elderly patients with gastric cardia cancer will be candidates for surgical resection. Age alone should not preclude surgical treatment in elderly patients with gastric cardia cancer and a tumor resection can be carried out safely. Certainly, we should take care in defining the surgical treatment in elderly patients, particularly as regarding the surgical approach; although the surgical approach does not influence the survival rate, the transhiatal way still remains the best one due, to the lower incidence of respiratory morbidity and thoracic pain.
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Affiliation(s)
- Natale Di Martino
- VIII Service of General Surgery and Gastroenterological Physiopathology, Second University of Study of Naples, Italy.
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Abstract
The dramatic increase in digestive surgery among patients of advanced age is the logical consequence of the aging population demographics in developed countries. Surgery in the aged is not fundamentally different, but it demands precise and tailored assessment and management of surgical indications and surgical and anesthetic techniques. Advanced age is not a contraindication to even major digestive surgery, but every effort must be made to avoid urgent operations by attention to pre-existing symptoms which are all-too-often neglected in the aged. Intensive care may help to shorten the hospital stay which should ideally occupy only a minor portion of the numbered days of the patient (whose life expectancy may be significantly longer than one may intuitively foresee).
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Affiliation(s)
- J J Duron
- Service de Chirurgie Générale, Hôpital de la Pitié Salpetrière, Paris.
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