Thuy B Tran1, David J Worhunsky1, Malcolm H Squires2, Linda X Jin3, Gaya Spolverato4, Konstantinos I Votanopoulos5, Carl Schmidt6, Sharon Weber7, Mark Bloomston6, Clifford S Cho7, Edward A Levine5, Ryan C Fields3, Timothy M Pawlik4, Shishir K Maithel2, Jeffrey A Norton1, George A Poultsides8. 1. Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA. 2. Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 3. Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University, St. Louis, MO, USA. 4. Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA. 5. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA. 6. Department of Surgery, The Ohio State University, Columbus, OH, USA. 7. Department of Surgery, University of Wisconsin, Madison, WI, USA. 8. Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA. gpoultsides@stanford.edu.
Abstract
BACKGROUND: As the U.S. population ages, an increasing number of elderly patients with gastric adenocarcinoma are being evaluated for surgical resection. This study aimed to describe the short- and long-term outcomes after gastric cancer resection for patients 80 years of age or older. METHODS: Patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012 at seven U.S. academic institutions were analyzed. The main outcome measures included postoperative morbidity, mortality, survival, and failure to rescue (defined as death after any complication). RESULTS: Of 953 patients who underwent distal or total gastrectomy during the 12-year study period, 127 (13 %) were 80 years of age or older. Although the type of postoperative complications did not differ between the two groups, octogenarians had a higher incidence of any (54 vs 41 %; p = 0.006) and of major (28 vs 17 %; p = 0.006) postoperative complications. This translated into higher 30-day (10.2 vs 3.6 %; p = 0.001) and 90-day mortality (19.7 vs 7.9 %; p = 0.001) rates, with correspondingly higher failure-to-rescue rates (17.4 vs 8 %; p = 0.015). However, disease-specific survival after resection was equivalent between the two groups (5-year survival: 46 vs 53 %; p = 0.676). In the multivariate analysis, age of 80 years or older, blood transfusion, and albumin and creatinine levels all were independent predictors of 90-day mortality. Stage, tumor grade, race, blood transfusion, and adjuvant therapy, but not age, were independently associated with disease-specific survival. CONCLUSION: Perioperative mortality and failure-to-rescue from complications is substantial for octogenarians undergoing gastric cancer resection. However, if the operation can be performed safely, the long-term cancer-specific outcome appears similar to that for younger patients.
BACKGROUND: As the U.S. population ages, an increasing number of elderly patients with gastric adenocarcinoma are being evaluated for surgical resection. This study aimed to describe the short- and long-term outcomes after gastric cancer resection for patients 80 years of age or older. METHODS:Patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012 at seven U.S. academic institutions were analyzed. The main outcome measures included postoperative morbidity, mortality, survival, and failure to rescue (defined as death after any complication). RESULTS: Of 953 patients who underwent distal or total gastrectomy during the 12-year study period, 127 (13 %) were 80 years of age or older. Although the type of postoperative complications did not differ between the two groups, octogenarians had a higher incidence of any (54 vs 41 %; p = 0.006) and of major (28 vs 17 %; p = 0.006) postoperative complications. This translated into higher 30-day (10.2 vs 3.6 %; p = 0.001) and 90-day mortality (19.7 vs 7.9 %; p = 0.001) rates, with correspondingly higher failure-to-rescue rates (17.4 vs 8 %; p = 0.015). However, disease-specific survival after resection was equivalent between the two groups (5-year survival: 46 vs 53 %; p = 0.676). In the multivariate analysis, age of 80 years or older, blood transfusion, and albumin and creatinine levels all were independent predictors of 90-day mortality. Stage, tumor grade, race, blood transfusion, and adjuvant therapy, but not age, were independently associated with disease-specific survival. CONCLUSION: Perioperative mortality and failure-to-rescue from complications is substantial for octogenarians undergoing gastric cancer resection. However, if the operation can be performed safely, the long-term cancer-specific outcome appears similar to that for younger patients.
Authors: Trevor D Hamilton; Alyson L Mahar; Barbara Haas; Kaitlyn Beyfuss; Calvin H L Law; Paul J Karanicolas; Natalie G Coburn; Julie Hallet Journal: Gastric Cancer Date: 2017-12-11 Impact factor: 7.370
Authors: Francesco Casella; Andrea Sansonetti; Andrea Zanoni; Cofini Vincenza; Alberto Capodacqua; Roberto Verzaro Journal: Updates Surg Date: 2017-05-10
Authors: Maciej Ciesielski; Wiesław Janusz Kruszewski; Mariusz Szajewski; Jakub Walczak; Natalia Spychalska; Jarosław Szefel; Jacek Zieliński Journal: J Gastric Cancer Date: 2019-05-09 Impact factor: 3.720