Is Extended Lymphadenectomy Needed for Elderly Patients With Gastric Adenocarcinoma?

Abstract

Extensive surgery is associated with greater mortality for elderly patients. For gastric adenocarcinoma (GA), it is unclear whether the benefit of an extended lymphadenectomy in this population outweighs the associated risks. This study aimed to determine the impact of lymphadenectomy on postoperative outcomes and survival for the elderly. To determine the impact of lymphadenectomy on postoperative outcomes and survival for elderly. From a cohort of 19 centers, patients who underwent resection of GA with curative intent between 1997 and 2010 were included in this study. Lymphadenectomy was defined according to the total number of lymph nodes in the surgical specimen (limited,<15; intermediate, 15-25; extended,>25). Postoperative outcomes and survival were compared between elderly (≥75years) and younger patients and regarding the extent of lymphadenectomy for the elderly. Of 1348 patients, 386 were elderly. The elderly presented with a higher American Society of Anesthesiologist (ASA) score (ASA 3-4: 45 vs. 16.5%; p<0.001) as well as greater postoperative morbidity (45 vs. 37%; p=0.009) and mortality (8 vs. 2.5%; p<0.001) despite less aggressive treatment including less neoadjuvant chemotherapy (5 vs. 20%; p<0.001) and adjuvant chemotherapy (7 vs. 44%; p<0.001), fewer total gastrectomies (41.5 vs. 60%; p<0.001), and less extended lymphadenectomy (38 vs. 48.5%; p<0.001). Among the elderly patients, limited lymphadenectomy (n=116), intermediate lymphadenectomy (n=125), and extended lymphadenectomy (n=145) were comparable with respect to tumor stage, perioperative treatment, morbidity, and mortality. For the elderly patients, overall survival (OS) was 30.8months, and disease-specific survival (DSS) was 63.9months. The extent of the lymphadenectomy did not have an impact on OS or DSS for the elderly patients. The expected benefit in terms of long-term survival did not justify an extended lymphadenectomy for elderly patients.