Skip to main content
Erschienen in: Annals of Surgical Oncology 2/2017

03.08.2016 | Gastrointestinal Oncology

Short- and Long-Term Outcomes After Gastrectomy in Elderly Gastric Cancer Patients

verfasst von: Jun-Young Yang, MD, Hyuk-Joon Lee, MD, PhD, Tae Han Kim, MD, Yeon-Ju Huh, MD, Young-Gil Son, MD, PhD, Ji-Ho Park, MD, Hye Seong Ahn, MD, PhD, Yun-Suhk Suh, MD, Seong-Ho Kong, MD, PhD, Han-Kwang Yang, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

The number of elderly patients undergoing gastric cancer surgery has recently increased. We therefore evaluated the short- and long-term outcomes of elderly patients after curative gastrectomy.

Methods

Overall, 824 patients were included in this retrospective study, which comprised of a non-elderly group (60–64 years; n = 558), an early-elderly group (75–79 years; n = 198), and a late-elderly group (≥80 years; n = 68) who underwent curative gastrectomy for gastric cancer between 2005 and 2009. Postoperative complications, according to the Clavien–Dindo classification, and survival of both elderly groups were compared with the non-elderly group. Postoperative life expectancy of the late-elderly group was compared with the corresponding aged general population.

Results

Overall and severe (grade III or higher) complications in the early-elderly group were comparable with the non-elderly group; however, those in the late-elderly group were significantly more common than in the non-elderly group (p = 0.013 and p = 0.043, respectively). Multivariable analysis revealed that age ≥80 years was an independent risk factor for severe complications (hazard ratio 3.02, 95 % confidence interval 1.12–8.17; p = 0.029), and the disease-specific survivals of both elderly groups were comparable with the non-elderly group in all TNM stages. Postoperative life expectancy of late-elderly patients eliminating death from recurrence was comparable with the corresponding aged general population eliminating death from gastric cancer.

Conclusions

Gastric cancer surgery in elderly patients aged ≥80 years achieves reasonable long-term survival despite the increased risk of severe complications.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Takeshita H, Ichikawa D, Komatsu S, et al. Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg. 2013;37(12):2891–8.CrossRefPubMed Takeshita H, Ichikawa D, Komatsu S, et al. Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg. 2013;37(12):2891–8.CrossRefPubMed
2.
Zurück zum Zitat Matsushita I, Hanai H, Kajimura M, et al. Should gastric cancer patients more than 80 years of age undergo surgery? Comparison with patients not treated surgically concerning prognosis and quality of life. J Clin Gastroenterol. 2002;35(1):29–34.CrossRefPubMed Matsushita I, Hanai H, Kajimura M, et al. Should gastric cancer patients more than 80 years of age undergo surgery? Comparison with patients not treated surgically concerning prognosis and quality of life. J Clin Gastroenterol. 2002;35(1):29–34.CrossRefPubMed
3.
Zurück zum Zitat Hayashi T, Yoshikawa T, Aoyama T, Ogata T, Cho H, Tsuburaya A. Severity of complications after gastrectomy in elderly patients with gastric cancer. World J Surg. 2012;36(9):2139–45.CrossRefPubMed Hayashi T, Yoshikawa T, Aoyama T, Ogata T, Cho H, Tsuburaya A. Severity of complications after gastrectomy in elderly patients with gastric cancer. World J Surg. 2012;36(9):2139–45.CrossRefPubMed
4.
Zurück zum Zitat Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53(3):424–9.CrossRefPubMed Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53(3):424–9.CrossRefPubMed
6.
Zurück zum Zitat Edge SB. American Joint Committee on Cancer. AJCC cancer staging manual. 7th ed. New York: Springer; 2010. Edge SB. American Joint Committee on Cancer. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
7.
Zurück zum Zitat Ahn HS, Lee HJ, Hahn S, et al. Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2010;116(24):5592–8.CrossRefPubMed Ahn HS, Lee HJ, Hahn S, et al. Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2010;116(24):5592–8.CrossRefPubMed
8.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Lee KG, Lee HJ, Yang JY, et al. Risk factors associated with complication following gastrectomy for gastric cancer: retrospective analysis of prospectively collected data based on the Clavien–Dindo system. J Gastrointest Surg. 2014;18(7):1269–77.CrossRefPubMed Lee KG, Lee HJ, Yang JY, et al. Risk factors associated with complication following gastrectomy for gastric cancer: retrospective analysis of prospectively collected data based on the Clavien–Dindo system. J Gastrointest Surg. 2014;18(7):1269–77.CrossRefPubMed
10.
Zurück zum Zitat Yamaguchi K, Yoshida K, Osada S, Takahashi T. Treatment of advanced gastric cancer in the elderly [in Japanese]. Nihon Geka Gakkai Zasshi. 2012;113(1):26–30.PubMed Yamaguchi K, Yoshida K, Osada S, Takahashi T. Treatment of advanced gastric cancer in the elderly [in Japanese]. Nihon Geka Gakkai Zasshi. 2012;113(1):26–30.PubMed
11.
Zurück zum Zitat Cho GS, Kim W, Kim HH, Ryu SW, Kim MC, Ryu SY. Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg. 2009;96(12):1437–42.CrossRefPubMed Cho GS, Kim W, Kim HH, Ryu SW, Kim MC, Ryu SY. Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg. 2009;96(12):1437–42.CrossRefPubMed
12.
Zurück zum Zitat Hwang SH, Park do J, Jee YS, et al. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg. 2009;208(2):186–92.CrossRefPubMed Hwang SH, Park do J, Jee YS, et al. Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg. 2009;208(2):186–92.CrossRefPubMed
13.
Zurück zum Zitat Kumagai K, Hiki N, Nunobe S, et al. Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy. Gastric Cancer. 2014;17(3):548–55.CrossRefPubMed Kumagai K, Hiki N, Nunobe S, et al. Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy. Gastric Cancer. 2014;17(3):548–55.CrossRefPubMed
14.
Zurück zum Zitat Eguchi T, Takahashi Y, Ikarashi M, Kasahara M, Fujii M. Is extended lymph node dissection necessary for gastric cancer in elderly patients? Eur J Surg. 2000;166(12):949–53.CrossRefPubMed Eguchi T, Takahashi Y, Ikarashi M, Kasahara M, Fujii M. Is extended lymph node dissection necessary for gastric cancer in elderly patients? Eur J Surg. 2000;166(12):949–53.CrossRefPubMed
15.
Zurück zum Zitat Orsenigo E, Tomajer V, Palo SD, et al. Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer. 2007;10(1):39–44.CrossRefPubMed Orsenigo E, Tomajer V, Palo SD, et al. Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer. 2007;10(1):39–44.CrossRefPubMed
16.
Zurück zum Zitat Hsu JT, Liu MS, Wang F, et al. 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(4):728–37.CrossRefPubMed Hsu JT, Liu MS, Wang F, et al. 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(4):728–37.CrossRefPubMed
17.
Zurück zum Zitat Mita K, Ito H, Hashimoto M, et al. Postoperative complications and survival after gastric cancer surgery in patients older than 80 years of age. J Gastrointest Surg. 2013;17(12):2067–73.CrossRefPubMed Mita K, Ito H, Hashimoto M, et al. Postoperative complications and survival after gastric cancer surgery in patients older than 80 years of age. J Gastrointest Surg. 2013;17(12):2067–73.CrossRefPubMed
18.
Zurück zum Zitat Sakurai K, Muguruma K, Nagahara H, et al. The outcome of surgical treatment for elderly patients with gastric carcinoma. J Surg Oncol. 2015;111(7):848–54.CrossRefPubMedPubMedCentral Sakurai K, Muguruma K, Nagahara H, et al. The outcome of surgical treatment for elderly patients with gastric carcinoma. J Surg Oncol. 2015;111(7):848–54.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Takeuchi D, Koide N, Suzuki A, et al. Postoperative complications in elderly patients with gastric cancer. J Surg Res. 2015;198(2):317–26.CrossRefPubMed Takeuchi D, Koide N, Suzuki A, et al. Postoperative complications in elderly patients with gastric cancer. J Surg Res. 2015;198(2):317–26.CrossRefPubMed
20.
Zurück zum Zitat Kurian AA, Wang L, Grunkemeier G, Bhayani NH, Swanstrom LL. Defining “the elderly” undergoing major gastrointestinal resections: receiver operating characteristic analysis of a large ACS-NSQIP cohort. Ann Surg. 2013;258(3):483–9.CrossRefPubMed Kurian AA, Wang L, Grunkemeier G, Bhayani NH, Swanstrom LL. Defining “the elderly” undergoing major gastrointestinal resections: receiver operating characteristic analysis of a large ACS-NSQIP cohort. Ann Surg. 2013;258(3):483–9.CrossRefPubMed
21.
Zurück zum Zitat Son T, Hyung WJ, Lee JH, Kim YM, Kim HI, An JY, et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer. 2012;118(19): 4687–93.CrossRefPubMed Son T, Hyung WJ, Lee JH, Kim YM, Kim HI, An JY, et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer. 2012;118(19): 4687–93.CrossRefPubMed
22.
Zurück zum Zitat Schmidt B, Yoon SS. D1 versus D2 lymphadenectomy for gastric cancer. J Surg Oncol. 2013;107(3):259–64.CrossRefPubMed Schmidt B, Yoon SS. D1 versus D2 lymphadenectomy for gastric cancer. J Surg Oncol. 2013;107(3):259–64.CrossRefPubMed
23.
Zurück zum Zitat Sano T, Coit DG, Kim HH, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer. 2016;20:1–9. Sano T, Coit DG, Kim HH, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer. 2016;20:1–9.
24.
Zurück zum Zitat Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.CrossRefPubMed Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901–8.CrossRefPubMed
25.
Zurück zum Zitat Kim SW, Han HS, Jung HW, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg. 2014;149(7):633–40.CrossRefPubMed Kim SW, Han HS, Jung HW, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg. 2014;149(7):633–40.CrossRefPubMed
26.
Zurück zum Zitat Hamamoto Y, Akutsu Y, Nagashima F, et al. Multicenter questionnaire survey on patterns of care for elderly patients with esophageal squamous cell carcinoma by the Japan Esophageal Oncology Group. Jpn J Clin Oncol. 2016;46(2):111–5.PubMed Hamamoto Y, Akutsu Y, Nagashima F, et al. Multicenter questionnaire survey on patterns of care for elderly patients with esophageal squamous cell carcinoma by the Japan Esophageal Oncology Group. Jpn J Clin Oncol. 2016;46(2):111–5.PubMed
27.
Zurück zum Zitat Zhou J, Yu P, Shi Y, et al. Evaluation of Clavien–Dindo classification in patients undergoing total gastrectomy for gastric cancer. Med Oncol. 2015;32(4):120.CrossRefPubMed Zhou J, Yu P, Shi Y, et al. Evaluation of Clavien–Dindo classification in patients undergoing total gastrectomy for gastric cancer. Med Oncol. 2015;32(4):120.CrossRefPubMed
28.
Zurück zum Zitat Jo JC, Baek JH, Koh SJ, et al. Adjuvant chemotherapy for elderly patients (aged 70 or older) with gastric cancer after a gastrectomy with D2 dissection: a single center experience in Korea. Asia Pac J Clin Oncol. 2015;11(4):282–7.CrossRefPubMed Jo JC, Baek JH, Koh SJ, et al. Adjuvant chemotherapy for elderly patients (aged 70 or older) with gastric cancer after a gastrectomy with D2 dissection: a single center experience in Korea. Asia Pac J Clin Oncol. 2015;11(4):282–7.CrossRefPubMed
29.
Zurück zum Zitat Tsushima T, Hironaka S, Boku N, et al. Safety and efficacy of S-1 monotherapy in elderly patients with advanced gastric cancer. Gastric Cancer. 2010;13(4):245–50.CrossRefPubMed Tsushima T, Hironaka S, Boku N, et al. Safety and efficacy of S-1 monotherapy in elderly patients with advanced gastric cancer. Gastric Cancer. 2010;13(4):245–50.CrossRefPubMed
30.
Zurück zum Zitat Song J, Lee HJ, Cho GS, et al. Recurrence following laparoscopy-assisted gastrectomy for gastric cancer: a multicenter retrospective analysis of 1417 patients. Ann Surg Oncol. 2010;17(7):1777–86.CrossRefPubMed Song J, Lee HJ, Cho GS, et al. Recurrence following laparoscopy-assisted gastrectomy for gastric cancer: a multicenter retrospective analysis of 1417 patients. Ann Surg Oncol. 2010;17(7):1777–86.CrossRefPubMed
Metadaten
Titel
Short- and Long-Term Outcomes After Gastrectomy in Elderly Gastric Cancer Patients
verfasst von
Jun-Young Yang, MD
Hyuk-Joon Lee, MD, PhD
Tae Han Kim, MD
Yeon-Ju Huh, MD
Young-Gil Son, MD, PhD
Ji-Ho Park, MD
Hye Seong Ahn, MD, PhD
Yun-Suhk Suh, MD
Seong-Ho Kong, MD, PhD
Han-Kwang Yang, MD, PhD
Publikationsdatum
03.08.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 2/2017
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5482-y

Weitere Artikel der Ausgabe 2/2017

Annals of Surgical Oncology 2/2017 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.