The outcome of surgical treatment for oldest-old patients with gastric cancer.

Abstract

40 Background: The number of the oldest-old patients with gastric cancer has been increasing in Japan. Selecting optimal operation for these patients is difficult because coping with both radicality and tolerability of surgery is mandatory. The aim of this study is to clarify the feasibility and effectiveness of gastrectomy for these patients. Methods: A total of 721 old patients (aged 75 years old and older) with gastric cancer who underwent curative gastrectomy at Shizuoka Cancer Center between from Oct. 2002 to Aug. 2015 were included in this study. The patients were classified into oldest-old group (OOP; aged 85 years and older) and old group (OP; aged 75 to 84 years old). Characteristics of the patients and short and long-term outcomes were compared between the groups. Results: OOP group included 57 patients, and OP group 664 patients. Though median serum albumin level in OOP group (3.8 g/dl) was significantly lower than in OP group (4.1 g/dl) (p = 0.002), the other clinicopathological characteristics including gender, BMI, co-morbidity, ASA-PS, ECOG-PS and preoperative stage were not significantly different between the groups. In terms of operative results, gastrectomy with reduced extent of lymph node dissection was frequently performed in OOP group (33.3%) than in OP group (6.0%) with significant difference (p < 0.001). Median operation time was significantly shorter in OOP group (195 minutes) than in OP group (222 minutes) (p = 0.001), and median blood loss was significantly less in OOP group (154 ml) than in OP group (227 ml) (p = 0.041). There was no significant difference of the incidence of postoperative complications between the groups. There was no significant difference of overall survival (p = 0.973) and disease-specific-survival (p = 0.549) between the groups. In multivariate analysis, preoperative BMI < 20, serum albumin < 3.8 g/dl and 15 days or more postoperative hospital stay were revealed as significant independent prognostic factors. Conclusions: Gastrectomy is safe with acceptable oncologic outcomes for OOP with optimally reducing the extent of surgery in each patient. In order to improve the outcome in OOP, preoperative nutritional management and support for home health care system should be considered.