Elderly Gastric Cancer Patients Research Articles

CLINICAL STUDY OF SURGICAL TREATMENT IN PATIENTS OVER 75 WITH GASTRIC AND COLORECTAL CANCER

In order to identify an adeqauate surgical treatment for elderly gastric and colorectal cancer patients, clinicopathological features and surgical results of the patients over 80 years of age were compared with those of patients between 75 and 79. Although more invasive procedures were performed for patients between 75 and 79, postoperative complications were higher in gastric cancer patients over 80 (94.7%) than in those between 75 and 79 (64.9%) (p<0.05). The incidence of postoperative pulmonary complications was higher in gastric cancer patients over 80 (73.7%) than in those between 75 and 79 (37.8%) (p<0.05). In colorectal cancer, complications which were not directly related to operative methods, i.e., pulmonary complications, occurred frequently in patients over 80. The cumulative survival rate was lower in patietns over 80. In particular, the prognosis of the patients over 80 with postoperative pulmonary complications was poor. The number of dissected lymph nodes and the incidence of combined resection of other organs were higher in the gastric cancer patients with postoperative pulmonary complications, and multiple proce-dures extending to the upper abdomen were frequently performed for colorectal cancer patients with pulmonary complications. These results suggest that radical lymph node dissection and combined resection of other organs in the treatment of aged patients with gastric cancer, and multiple procedures extending to the upper abdomen in aged colorectal cancer patients, should be minimized to prevent postoperative complications and improve the prognosis.

Time trends in diagnostic strategy, treatment, and prognosis of gastric cancer in the elderly: a population based study.

The impact of changes in diagnostic strategies for gastric cancer and attitudes towards surgery in elderly patients is not known. A population-based series of 842 gastric cancers diagnosed between 1976 and 1993 in patients aged 70 and older in Côte-dOr, France, was used to establish trends in diagnostic strategy, treatment, and prognosis. The use of endoscopy alone increased from 3% (1976-78) to 81% (1991-93). This trend was initially associated with a decrease in the use of x-ray alone, then with a decrease in the use of both x-ray and endoscopy. The proportion of resection for cure increased from 26% during 1976-78 to 43% during 1991-93 (P < 0.001). The proportion of cancers not extending beyond the gastric wall increased from 12% to 24% (P < 0.05). Operative mortality decreased from 38.7% (1976-78) to 13.3% (1991-93) and the corresponding 3-year crude survival rate rose from 7% to 18%. Improvements in the care of gastric cancer in elderly patients have been achieved, but further progress is warranted.

Surgery for Gastric Cancer Patients Aged 75 and Over

To analyze the clinicopathological characteristics and surgical results in very elderly gastric cancer patients, we reviewed 129 patients aged 75 years and over (group 1) and 708 patients younger than 60 years (group 2) as controls. There were significant differences between group 1 and group 2 with regard to the preoperative impairment of cardiac, respiratory, liver and renal function. The maximum dimension of the tumor in group 1 was greater than that in group 2, and lymph node metastases were more common in group 1. Although reduced lymph node dissection was performed more frequently in group 1 than in group 2, the operative mortality in group 1 (8.5%) was significantly higher than that in group 2 (2.5%, p = 0.002). Among the causes of operative mortality, anastomotic leakage was the most common in the both groups (group 1 36.3%; group 2 44.4%). With regard to the long-term results, although a significant difference in the cumulative 5 -year survival rate was detected in stage I or II patients (group 1 52.2%; group 2 91.1%; p < 0.001), there was no significant difference in survival in stage III or IV patients (group 1 23.3%; group 2 38.7%). In conclusion, diligent preoperative and postoperative care combined with rational surgical procedures are indispensable to prevent postoperative complications in very elderly patients. However, as satisfactory long-term results can be expected, even in very elderly patients, the option of surgery for gastric cancer should not be abandoned solely because of age.

Etoposide, leucovorin, 5-fluorouracil and interferon alpha-2?b in elderly gastric cancer patients: a pilot study

Etoposide, leucovorin, 5-fluorouracil and interferon alpha-2?b in elderly gastric cancer patients: a pilot study

Etoposide, leucovorin, 5-fluorouracil and interferon alpha-2b in elderly gastric cancer patients: a pilot study

A total of 23 advanced gastric cancer patients older than 65 years received 500 mg/m2 5-fluorouracil i.v. on days 2-4, 120 mg/m2 vepesid i.v. on days 2-4, 150 mg/m2 6S-leucovorin on days 2-4, and 5 MU/m2 interferon alpha-2b on days 1-5, with cycles being repeated every 3 weeks. Toxicity was severe at an interferon (IFN) dose of 5 MU/m2; only one patient tolerated this dose. In 18 patients an IFN dose of 3 MU/m2 and in 3 other patients a dose of 4 MU/m2 could be given without producing toxicity. At an IFN dose of 5 MU/m2 the most common toxicities encountered were stomatitis (grade 4 in 1 patient and grade 3 in 12 patients), leukopenia (grade 4 in 1 patient and grade 3 in 5 patients), and thrombocytopenia (grade 3 in 3 patients). Two patients achieved a complete response and eight showed a partial response, resulting in an overall response rate of 45% [95% confidence interval (CI), 25%-64%]. The median survival was 7 months for all patients and 9 months for responding patients. In conclusion, without substantially increasing the toxicity, IFN can be added to the etoposide/leucovorin/5-fluorouracil combination, at a dose of 3 MU/m2. To verify the possible enhancement by IFN of the activity of this combination, a randomized trial is under way.

SURGICAL CASES OF GASTRIC CANCER IN PATIENTS OVER 80 YEARS OLD

Twenty-two elderly (over 80 years old) gastric cancer patients undergone operations were subjected to a review of the preoperative examination results, types of operation, complication rate, and hosptial mortality. Early gastric cancers of protruded type and advanced gastric cancers of Type Borrmann 3 in lower third (region A) were common. The resection rate was 95.5%; the curative resection rate, 55.6%; the complication rate, 45.5%; hospital mortality, 18.2%; and operative mortality, 4.5%. In the preoperative examinations, the highest incidence of abnormal data was shown at the lung (68.2%), followed by those at the liver and the heart. The pulmonary complications occupied 70% of the postoperative complications. In the group having four or more abnormal items in the preoperative examinations, the complication rate was 71.4%, and hospital mortality rate was 42.9%. There were no significant correlations between the resected area of R-number (extent of lymph node removal), and complication rate or hospital mortality. The five-year survival rate of curative resection cases was a favorable 77.8%. For enhancement of the operative result, the determination of an adequate region for resection and selective dissection of associated lymph nodes are both necessary, depending on the general status and local findings. Temporary gastrostomy with fine calibre tube, as well as forbiding smoking, chest physiotherapy, and tracheal cleaning, was beneficial to prevent pulmonary complications.

Factors Influencing the Postoperative Course 113 Patients With Early Gastric Cancer

One hundred and thirteen patients with early gastric cancer operated on during the period from 1967 to 1982 were followed up until 1985; 24 of them died. The 5- and 10-year cumulative survival rates of 99 patients, excluding 14 (12.4%) who died of diseases unrelated to gastric cancer, were 97.8% and 89.1%, respectively. Of the 24 deaths, seven were due to recurrence of gastric cancer, one to pulmonary metastasis found preoperatively and 16 to diseases unrelated to gastric cancer. Recurrence took the form hepatic metastasis in four cases, bone metastasis in two and recurrence in the gastric remnant in one. The metastases were distant in the majority of cases of recurrence, and recurrence characteristically occurred late, with six patients dying more than 5 years and one dying 10 years after surgery. The recurrences were mostly found in patients with poorly differentiated adenocarcinoma. On the other hand, the causes of death in 16 patients were diseases unrelated to gastric cancer, i.e., primary cancer of other organs in six, operative complications, heart diseases, senility, and pneumonia in two each, and a traffic accident and apoplexy in one each. Thus, Many of the deaths were due to primary cancer of other organs. Four patients underwent non-curative resection. One had lung metastasis found preoperatively and the remaining three had positive margins. The latter three did not undergo a second operation, but the causes of their deaths were not recurrence of gastric cancer. It is necessary to follow up patients from the standpoint not only of recurrence of gastric cancer, but also of diseases other than gastric cancer and multiple gastric cancer in elderly patients.