Skip to main content
Erschienen in: World Journal of Surgery 11/2019

06.08.2019 | Original Scientific Report

Postoperative Long-Term Outcomes in Elderly Patients with Gastric Cancer and Risk Factors for Death from Other Diseases

verfasst von: Tadayoshi Hashimoto, Yukinori Kurokawa, Jota Mikami, Tsuyoshi Takahashi, Yasuhiro Miyazaki, Koji Tanaka, Tomoki Makino, Makoto Yamasaki, Masaaki Motoori, Yutaka Kimura, Kiyokazu Nakajima, Masaki Mori, Yuichiro Doki

Erschienen in: World Journal of Surgery | Ausgabe 11/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

Elderly patients with gastric cancer are frequently treated surgically in current clinical practice. Although several studies have investigated short-term outcomes after gastrectomy in elderly patients, most did not evaluate long-term outcomes.

Methods

We analyzed 1154 consecutive patients who underwent curative gastrectomy for gastric cancer between 2001 and 2013. We classified them into two groups: the elderly group (n = 241), consisting of patients aged ≥75 years, and the non-elderly group (n = 913), consisting of patients aged <75 years, and compared the short- and long-term outcomes between the two groups. The risk factors for death from other diseases in elderly patients were also examined.

Results

Although the incidence of postoperative pneumonia was significantly higher in the elderly group (P < 0.001), the proportion of overall postoperative complications did not differ significantly between the two groups (P = 0.097). The disease-specific survival was similar between the two groups (P = 0.743), whereas the overall survival in the elderly group was significantly shorter than that in the non-elderly group (P < 0.001) because of a higher incidence of death from other diseases throughout all gastric cancer stages. Multivariate analysis revealed that a low preoperative prognostic nutrition index (PNI) and multiple comorbidities were significant risk factors for death from other diseases within 5 years in the elderly group.

Conclusions

Despite acceptable short-term outcomes, long-term outcomes in elderly patients with gastric cancer were poor due to the high incidence of death from other diseases. Indications for surgery in elderly patients with a low PNI or multiple comorbidities should be considered carefully.
Literatur
1.
Zurück zum Zitat Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386CrossRef Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386CrossRef
2.
Zurück zum Zitat Bray F, Jemal A, Grey N et al (2012) Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol 13:790–801CrossRef Bray F, Jemal A, Grey N et al (2012) Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol 13:790–801CrossRef
3.
Zurück zum Zitat Colvin H, Mizushima T, Eguchi H et al (2017) Gastroenterological surgery in Japan: the past, the present and the future. Ann Gastroenterol Surg 1:5–10CrossRef Colvin H, Mizushima T, Eguchi H et al (2017) Gastroenterological surgery in Japan: the past, the present and the future. Ann Gastroenterol Surg 1:5–10CrossRef
4.
Zurück zum Zitat Hashimoto T, Kurokawa Y, Mori M et al (2018) Update on the treatment of gastric cancer. JMA J 1:40–49CrossRef Hashimoto T, Kurokawa Y, Mori M et al (2018) Update on the treatment of gastric cancer. JMA J 1:40–49CrossRef
5.
Zurück zum Zitat Mukai Y, Kurokawa Y, Takiguchi S et al (2017) Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume? Ann Gastroenterol Surg 1:186–192CrossRef Mukai Y, Kurokawa Y, Takiguchi S et al (2017) Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume? Ann Gastroenterol Surg 1:186–192CrossRef
6.
Zurück zum Zitat Katai H, Sasako M, Sano T et al (2004) Gastric cancer surgery in the elderly without operative mortality. Surg Oncol 13:235–238CrossRef Katai H, Sasako M, Sano T et al (2004) Gastric cancer surgery in the elderly without operative mortality. Surg Oncol 13:235–238CrossRef
7.
Zurück zum Zitat Schlesinger-Raab A, Mihaljevic AL, Egert S et al (2016) Outcome of gastric cancer in the elderly: a population-based evaluation of the Munich Cancer Registry. Gastric Cancer 19:713–722CrossRef Schlesinger-Raab A, Mihaljevic AL, Egert S et al (2016) Outcome of gastric cancer in the elderly: a population-based evaluation of the Munich Cancer Registry. Gastric Cancer 19:713–722CrossRef
8.
Zurück zum Zitat Takeuchi D, Koide N, Suzuki A et al (2015) Postoperative complications in elderly patients with gastric cancer. J Surg Res 198:317–326CrossRef Takeuchi D, Koide N, Suzuki A et al (2015) Postoperative complications in elderly patients with gastric cancer. J Surg Res 198:317–326CrossRef
9.
Zurück zum Zitat Liang YX, Deng JY, Guo HH et al (2013) Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years. World J Gastroenterol 19:6568–6578CrossRef Liang YX, Deng JY, Guo HH et al (2013) Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years. World J Gastroenterol 19:6568–6578CrossRef
10.
Zurück zum Zitat Mikami J, Kurokawa Y, Miyazaki Y et al (2015) Postoperative gastrectomy outcomes in octogenarians with gastric cancer. Surg Today 45:1134–1138CrossRef Mikami J, Kurokawa Y, Miyazaki Y et al (2015) Postoperative gastrectomy outcomes in octogenarians with gastric cancer. Surg Today 45:1134–1138CrossRef
11.
Zurück zum Zitat Orsenigo E, Tomajer V, Palo SD et al (2007) Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer 10:39–44CrossRef Orsenigo E, Tomajer V, Palo SD et al (2007) Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer 10:39–44CrossRef
13.
Zurück zum Zitat Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRef Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRef
14.
Zurück zum Zitat Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRef Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRef
15.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 40:205–213CrossRef Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 40:205–213CrossRef
16.
Zurück zum Zitat Katayama H, Kurokawa Y, Nakamura K et al (2016) Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today 46:668–685CrossRef Katayama H, Kurokawa Y, Nakamura K et al (2016) Extended Clavien–Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today 46:668–685CrossRef
17.
Zurück zum Zitat Hamakawa T, Kurokawa Y, Mikami J et al (2016) Risk factors for postoperative complications after gastrectomy in gastric cancer patients with comorbidities. Surg Today 46:224–228CrossRef Hamakawa T, Kurokawa Y, Mikami J et al (2016) Risk factors for postoperative complications after gastrectomy in gastric cancer patients with comorbidities. Surg Today 46:224–228CrossRef
18.
Zurück zum Zitat Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85:1001–1005PubMed Onodera T, Goseki N, Kosaki G (1984) Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi 85:1001–1005PubMed
19.
Zurück zum Zitat Yamada H, Shinohara T, Takeshita M et al (2013) Postoperative complications in the oldest old gastric cancer patients. Int J Surg 11:467–471CrossRef Yamada H, Shinohara T, Takeshita M et al (2013) Postoperative complications in the oldest old gastric cancer patients. Int J Surg 11:467–471CrossRef
20.
Zurück zum Zitat Takama T, Okano K, Kondo A et al (2015) Predictors of postoperative complications in elderly and oldest old patients with gastric cancer. Gastric Cancer 18:653–661CrossRef Takama T, Okano K, Kondo A et al (2015) Predictors of postoperative complications in elderly and oldest old patients with gastric cancer. Gastric Cancer 18:653–661CrossRef
21.
Zurück zum Zitat Miki Y, Makuuchi R, Tokunaga M et al (2016) Risk factors for postoperative pneumonia after gastrectomy for gastric cancer. Surg Today 46:552–556CrossRef Miki Y, Makuuchi R, Tokunaga M et al (2016) Risk factors for postoperative pneumonia after gastrectomy for gastric cancer. Surg Today 46:552–556CrossRef
22.
Zurück zum Zitat Shaker R, Easterling C, Kern M et al (2002) Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 122:1314–1321CrossRef Shaker R, Easterling C, Kern M et al (2002) Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 122:1314–1321CrossRef
23.
Zurück zum Zitat Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762CrossRef Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762CrossRef
24.
Zurück zum Zitat Saidi RF, Bell JL, Dudrick PS (2004) Surgical resection for gastric cancer in elderly patients: is there a difference in outcome? J Surg Res 118:15–20CrossRef Saidi RF, Bell JL, Dudrick PS (2004) Surgical resection for gastric cancer in elderly patients: is there a difference in outcome? J Surg Res 118:15–20CrossRef
25.
Zurück zum Zitat Endo S, Shimizu Y, Ikenaga M et al (2017) Survival benefit of gastrectomy for gastric cancer in patients ≥ 85 years old: a retrospective propensity score-matched analysis. Surgery 161:984–994CrossRef Endo S, Shimizu Y, Ikenaga M et al (2017) Survival benefit of gastrectomy for gastric cancer in patients ≥ 85 years old: a retrospective propensity score-matched analysis. Surgery 161:984–994CrossRef
26.
Zurück zum Zitat Ueno D, Matsumoto H, Kubota H et al (2017) Prognostic factors for gastrectomy in elderly patients with gastric cancer. World J Surg Oncol 15:1131–1136CrossRef Ueno D, Matsumoto H, Kubota H et al (2017) Prognostic factors for gastrectomy in elderly patients with gastric cancer. World J Surg Oncol 15:1131–1136CrossRef
27.
Zurück zum Zitat Ramesh HS, Pope D, Gennari R et al (2005) Optimising surgical management of elderly cancer patients. World J Surg Oncol 3:17CrossRef Ramesh HS, Pope D, Gennari R et al (2005) Optimising surgical management of elderly cancer patients. World J Surg Oncol 3:17CrossRef
28.
Zurück zum Zitat Saif MW, Makrilia N, Zalonis A et al (2010) Gastric cancer in the elderly: an overview. Eur J Surg Oncol 36:709–717CrossRef Saif MW, Makrilia N, Zalonis A et al (2010) Gastric cancer in the elderly: an overview. Eur J Surg Oncol 36:709–717CrossRef
29.
Zurück zum Zitat Ouchi Y, Rakugi H, Arai M et al (2017) Redefining the elderly as aged 75 years and older: proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int 17:1045–1047CrossRef Ouchi Y, Rakugi H, Arai M et al (2017) Redefining the elderly as aged 75 years and older: proposal from the Joint Committee of Japan Gerontological Society and the Japan Geriatrics Society. Geriatr Gerontol Int 17:1045–1047CrossRef
Metadaten
Titel
Postoperative Long-Term Outcomes in Elderly Patients with Gastric Cancer and Risk Factors for Death from Other Diseases
verfasst von
Tadayoshi Hashimoto
Yukinori Kurokawa
Jota Mikami
Tsuyoshi Takahashi
Yasuhiro Miyazaki
Koji Tanaka
Tomoki Makino
Makoto Yamasaki
Masaaki Motoori
Yutaka Kimura
Kiyokazu Nakajima
Masaki Mori
Yuichiro Doki
Publikationsdatum
06.08.2019
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 11/2019
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-019-05109-5

Weitere Artikel der Ausgabe 11/2019

World Journal of Surgery 11/2019 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.