Surgery of gastric cancer in the elderly

The results of surgical treatment of gastric cancer in the elderly (aged over 70) were retrospectively studied in a group of 110 patients operated between 1988 and 1996 in our hospital. The ratio male/female was 3:1. In 101 cases (91.81%) the preoperative assessment included upper GI endoscopy, abdominal echography, CT scan and tumor markers screening sampling. Since 1994, a diagnostic laparoscopic evaluation was held in 22 cases (21.78%). The remaining 9 patients (8.18%) presented bleeding tumors (6 cases) or obstructing disseminated carcinomas (3 cases) and therefore were treated through an emergency procedure. Three groups of patients were considered regarding the resectability and/or the type of procedure. The first group (A) concerned 16 patients (14.54%) who underwent bypassing procedures due to unresectable tumors (large adenocarcinomas and metastatic disease). The second group (B) included 82 cases (74.54%) treated by partial gastrectomy, whereas in group (C) (12 patients, 10.90%) a total gastrectomy was performed, with or without extended lymphadenectomy. Seven patients of this group (C) (58.33%) underwent extended lymphadenectomy and splenectomy, in one case (8.33%) a traumatic splenectomy was performed, and in 4 cases (33.33%) a simple total resection was held. The postoperative morbidity and mortality rates were strongly related to the advanced age. Thirty-one cases (28.18%) presented cardiovascular, pulmonary or renal complications and 7 patients (6.36%) died due to pulmonary complications (ARDS). Two patients (1.81%) were lost due to anastomotic dehiscence. Group (B) and (C) specimens revealed 71 well or moderately differentiated adenocarcinomas (76.53%), 21 anaplastic carcinomas (22.34%) and 2 malignant lymphomas (2.12%). The overall survival rate was 28.6 months (mean). It seems that pre-H2 antagonists population presents an increased incidence of gastric cancer, but their less aggressive histologic feature advocated our resecting policy. We consider that neoadjuvant postoperative therapy has no place in this aged population although a controversy is still held on this matter. On the other hand, life expectancy rate in the elderly, as well as the increased frequency of lethal postoperative complications suggests a more conservative surgical approach in this particular patient population.