Abstract
BackgroundHigh perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group.MethodsOctogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004–2013.ResultsPatients age ≥ 80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p < 0.001), especially in early stage patients. However, additional chemotherapy (HR: 0.94, 95% CI: 0.82–1.08, P = 0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84–1.13, P = 0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51–0.86, P = 0.002) was a significant independent prognostic factor, while extensive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22–2.91, P = 0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97–1.00, P = 0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18–27% in other programs, P < 0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6–6.6% in other programs, P < 0.001; 90-day mortality: 6.2% in AR vs. 13.6–16.4% in other programs, P < 0.001) compared to other facilities.ConclusionsLess-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs. with early stage resectable PGC.
Highlights
High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians
Wang et al BMC Cancer (2019) 19:1079 reported that surgery for gastric carcinoma in the elderly has acceptable perioperative morbidity and mortality [15, 16], and have further demonstrated a survival benefit of surgical resection compared to the non-operative management in elderly patients with stage I-III gastric carcinoma [17]
Overall trend of surgery in elderly patients A total of 59,698 patients with proximal gastric carcinoma identified from National Cancer Database (NCDB) were initially screened into three age groups (< 60 yrs.: n = 16,766; 60–79 yrs.: n = 32,931; and ≥ 80 yrs.: n = 10,001)
Summary
Mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. Previous studies have reported conflicting outcomes for patients age 80 years and older (≥80 yrs) with gastric carcinoma who undergo surgery [10,11,12,13]. Wang et al BMC Cancer (2019) 19:1079 reported that surgery for gastric carcinoma in the elderly has acceptable perioperative morbidity and mortality [15, 16], and have further demonstrated a survival benefit of surgical resection compared to the non-operative management in elderly patients with stage I-III gastric carcinoma [17]. As the incidence of proximal gastric carcinoma continues to rise, this is a challenging treatment dilemma that requires urgent attention [11]
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