Abstract
Introduction: Gastric cancer is the 4th most common malignancy and second leading cause of cancer-related death worldwide, both its incidence and mortality have decreased over the past 70 years. Advancing life expectancy, as well as subtle change in the type and location of gastric cancer in the US, has resulted in an increased number of elderly patients requiring gastric surgery. By 2050, the population older than 85 years is projected to reach 20.9 million, and as a result, the need to assess the operative outcomes and mortality following gastrectomy in this group is imperative. This study sought to assess age-related clinical outcomes following gastric cancer surgery across all age groups to provide more precise data for pre-operative surgical risk stratification. Methods: Discharge data on 40,276,240 patients was collected from Nationwide Inpatient Sample Database (NIS) (2004-2008). Data on patients undergoing gastrectomy as the primary procedure was analyzed including age, gender, elective/non-elective admission, pre-operative length of stay (LOS), total LOS, and mortality. Eight age groups were compared for two procedures: total gastrectomy (TG) and partial gastrectomy (PG). Categorical data was compared using the Chi square test and continuous data using the Student’s t test. Univariate analysis and multivariate regression analysis were performed to assess independent variables. Results: 13,799 patients underwent gastrectomy surgery with 23.7% having TG and 76.3% PG. Gastric carcinoma was the most common indication for TG, while benign gastric disease was more common for PG, especially in years 51 - 70 (p ± 12.8 and 64 ± 15 years respectively. Males underwent twice the number of TGs (p p % change noted in those 41 - 50 years (1500%). PGs performed decreased overall, especially in patients 81 years with the greatest % change in the oldest patients >91 years (13%). Non-elective admissions were more common for PGs (N = 4844, 41%) than TGs (N = 695, 21.2%). Mean pre-operative LOS and total LOS increased with advancing age for both TG and PG (p p = 0.001). Respiratory (18%) and GI complications (11%) were the most common post-operative complications following TG, while GI (9.6%) and bile duct fistulas (7.2%) were most common after PG. Overall TG and PG mortality rates were 7.6% and 6.4% respectively. Mortality increased with advancing age in both groups (p p = 0.001). Conclusions: Advancing age is not an independent predictor of mortality following gastric surgery. Gastrectomy for gastric cancer is associated with a higher mortality than for benign gastric diseases. Non-elective admission, and pre-existing hypertension, valvular disease and anemia independently predicted increased morbidity and mortality following gastric surgery and should be carefully considered in surgical planning and counseling. Gastric carcinoma is the most common indication for TG, while benign gastric disease is a more common indication for PG. The number of TGs performed is increasing, especially in the males and younger patients, and may reflect an increased incidence of body and cardiac lesions.
Highlights
Gastric cancer is the 4th most common malignancy and second leading cause of cancer-related death worldwide, both its incidence and mortality have decreased over the past 70 years
13,799 patients identified in the Nationwide Inpatient Sample Database (NIS) underwent either total gastrectomy (TG) or partial gastrectomy (PG) between 2004 and 2008, and formed the study population
The largest number of TG were performed in patients age 61 - years (N = 980, 30%), whereas the largest number of PG were performed in those age - 80 years (N = 2436, 23.1%)
Summary
Gastric cancer is the 4th most common malignancy and second leading cause of cancer-related death worldwide, both its incidence and mortality have decreased over the past 70 years. This study sought to assess age-related clinical outcomes following gastric cancer surgery across all age groups to provide more precise data for pre-operative surgical risk stratification. Non-elective admission, and pre-existing hypertension, valvular disease and anemia independently predicted increased morbidity and mortality following gastric surgery and should be carefully considered in surgical planning and counseling. There is a growing and important need to have precise information related to the operative risks, outcomes and mortality following gastrectomy in elderly patients in order to improve surgical decision making and patient counseling. This study sought to compare population-based outcomes following gastrectomy across a wide range of age groups to determine whether advancing age, or other factors, were independently associated with increased morbidity and mortality
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
