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06.09.2022 | Original Article

Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3

verfasst von: Keiji Nishibeppu, Shinichi Sakuramoto, Kazuaki Matsui, Gen Ebara, Shohei Fujita, Shiro Fujihata, Shuichiro Oya, Seigi Lee, Yutaka Miyawaki, Hirofumi Sugita, Hiroshi Sato, Keishi Yamashita

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 8/2022

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Abstract

Background

Although the American Society of Anesthesiologists (ASA) score of 3 is relatively common in elderly patients, there have been few debates on the indications for gastrectomy in elderly gastric cancer (GC) patients with ASA3. Therefore, this study aimed to investigate gastrectomy’s clinical relevance in elderly patients with GC and ASA3.

Methods

We retrospectively analyzed 228 consecutive elderly GC patients (aged ≥ 75 years) without prior treatments who underwent curative gastrectomy between 2013 and 2017.

Results

Thirty-three patients with ASA3 showed significantly poorer prognosis than those with ASA1 and 2 (p = 0.004). The multivariate Cox proportional hazards model showed that ASA3 (p = 0.021) and pStage (p = 0.007) were independent prognostic factors, respectively. Elderly GC patients with pStage III and ASA3 exhibited uniquely dismal prognosis (p < 0.001); however, several survivors were still confirmed. Postoperative complications (PCs) were only the final remnant independent prognostic factor (p = 0.020) among the 33 elderly GC patients with ASA3, where dead patients included cancer-specific and other deaths, especially pneumonia. PCs were independently associated with prognostic nutritional index (PNI) (< 42.7) in elderly GC patients, and the most frequent complication was pneumonia, which was significantly associated with ASA3 and marginally associated with PNI in a multivariate analysis.

Conclusions

ASA3 has a dismal prognosis after curative gastrectomy in the elderly GC patients, but the number of survivors was confirmed. Curative gastrectomy is not considered contraindicated even in elderly GC with ASA3. Preoperative malnutrition is associated with PCs, which proposing preoperative nutritional intervention in the context of treatment strategy for the elderly GC patients with ASA3.

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Titel: Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3
verfasst von: Keiji Nishibeppu
Shinichi Sakuramoto
Kazuaki Matsui
Gen Ebara
Shohei Fujita
Shiro Fujihata
Shuichiro Oya
Seigi Lee
Yutaka Miyawaki
Hirofumi Sugita
Hiroshi Sato
Keishi Yamashita
Publikationsdatum: 06.09.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 8/2022
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-022-02672-9

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Dismal prognosis of elderly gastric cancer patients who underwent gastrectomy with American Society of Anesthesiologists (ASA) 3