Should Advanced Age Preclude Surgical Treatment of Gastrointestinal Stromal Tumor?

Abstract

Introduction: Surgical resection is a gold standard treatment for gastrointestinal stromal tumors (GISTs). It can be performed by minimally invasive surgery approach in most of the patients. It has been shown that advanced age is not a clear poor prognostic factor in patients who underwent surgery for GIST. We hypothesized that elderly patients undergo elective surgery less often compared to younger population. We aim to evaluate the safety, efficacy and oncological results of GIST treatment in the elderly population in our Medical Center. Materials and Methods: All patients who underwent surgery for GIST in Shamir Medical Center from January 1, 2016, to July 31, 2023, were included in the study. The patients were divided into 2 groups. Group 1 included patients younger than 75 years, while patients older than 75 years were included in Group 2. The groups were compared according to demographics, clinical and surgical parameters, complications, and pathology results. Results: Overall, 49 patients were included in the study. Group 1 included 28 patients and Group 2 included 21 patients. Group 2 patients more often underwent emergency surgery (52.4% versus 14.3%, P < .05) and had increased open surgery rate (19% versus 0%, P < .05). No difference between the groups was noted in surgical parameters, complications, and length of hospital stay. Tumor size, number of mitoses, level of ki67%, and involvement of surgical margins were not significantly different. However, in Group 2 patients, tumor size was larger and there was a trend toward higher rate of ki67 > 5%. Conclusion: Elderly patients with GIST are less frequently undergoing electively surgery and relatively often undergo open surgery. Frequency of complications is similar in elderly patients compares to younger patients group.