Abstract
163 Background: Average life expectancy is increased to 82.6-year-old nowadays in Japan, and there is the increase of the number of elderly patients diagnosed with gastric cancer. Methods: From 1991 to 2011, 5330 operations have been performed for patients diagnosed with gastric cancer in our hospital, and 78 patients (1.5%) were over 85-year-old (elder group). To analyze the problems of surgical treatment for the extremely aged patients, the clinic-pathological findings were investigated retrospectively and compared with those in 4494 patients under 75 years old (control group). Results: Median age of elderly group was 86 (85-95) and control group was 63 (19-75). Preoperative morbidity was higher in the elderly group than in control group (73.1% vs 23.2%,p<0.001). The operative prosedures such as local/proximal/distal/total were 9/0/49/20 in elderly group and 216/172/2983/1123 in control group. The ratio of D2/D3 nodal dissection was lower in elderly group than in control group (30.8/0% vs 48.1/5.4%). Operation-time/blood-loss was less invasive in elderly group (135min/70ml vs 165min/100ml,p<0.001), but the postoperative morbidity rate was higher in elderly group (24.4% vs 15.3%,p=0.029). Although the frequency of postoperative complications was similar in surgical field, (14.1% vs 13.1%), other morbidity such as pneumonia, cerebral infarction and renal impairment were more common in elderly group. There was no difference in postoperative hospital stay in two groups (15 days). The ratio of postoperative adjuvant chemotherapy was lower in elderly group (Stage II/III; 10.0/13.3% vs 54.2/67.9%). The best supportive care is highly selected in elderly group in case of recurrence (66.7% vs 11.9%). The overall 5-year survival rate of Stage I/II/III/IV was 70.6/70.0/30.3/0% in elderly group and 92.0/80.0/60.5/13.3% in control group. The ratio of non-cancer death was higher in elderly group (41% vs 14%,p<0.001). Conclusions: The postoperative morbidity and non-cancer death is higher in elderly group. With the restriction for treatment failure, appropriate surgical procedures such as minimally invasive surgery and attentive care for the morbidity would need for the extremely aged patients for their better quality of life.
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