Feasibility of radical gastrectomy for elderly patients with gastric cancer

Background: The aim of this study was to evaluate the short-term safety and long-term benefits of radical gastrectomy for gastric cancer in elderly patients. Methods: A total of 729 patients undergoing gastrectomy for adenocarcinoma between December 2008 and December 2011 were enrolled in this retrospective study. Patients were divided into three groups: young group (<65 years), young old group (65-79 years) and old old group (80 years). Results: Lower albumin levels, higher ASA grades, comorbidities, tumors located in the upper third of the stomach and advanced TNM stages were more common in the young old and old old age groups. Overall complications increased significantly with advancing age (15.4%, 24.9%, 48.7%, respectively); respiratory complications largely contributed to the dramatic increase. Severe complications were similar between the young and young old groups (3.9%, 3.7%), but were significantly increased in the old old group (12.8%). In multivariate analysis, old old age, multiple comorbidities and no epidural use were strong predictors for overall complications. Both overall survival and disease-specific survival (DSS) rates declined with advancing age. Multivariate analysis showed that old old age and TNM stage >= II were major independent risk factors for the DSS rate. When adjusted for confounding factors, young old age was not a risk factor. The median survival time for the old old patients with stage III tumors was 12.9 months. Conclusions: It is relatively safe and beneficial for young old patients to undergo radical gastrectomy as the young patients. However, the decision to perform radical gastrectomy for old old patients with TNM stage III tumors should be made carefully. (C) 2015 Elsevier Ltd. All rights reserved.