Open AccessPrognostic Factors Affecting Short- and Long-Term Outcomes of Gastrectomy for Gastric Cancer in Older Patients
Author(s) -
Nobuhiro Tsuchiya,
Chikara Kunisaki,
Hiroki Kondo,
Shigeo Sato,
Kei Sato,
Jun Watanabe,
Kazuhisa Takeda,
Takashi Kubo,
Hirotoshi Akiyama,
Itaru Endo
Publication year - 2022
Publication title -
digestive surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.762
H-Index - 69
eISSN - 1421-9883
pISSN - 0253-4886
DOI - 10.1159/000524609
Subject(s) - medicine , gastrectomy , odds ratio , hazard ratio , cancer , perioperative , retrospective cohort study , confidence interval , gastroenterology , surgery , neutrophil to lymphocyte ratio , overall survival
The benefits of surgery in older patients with gastric cancer are controversial. This single-institution retrospective study in Japan aimed to evaluate the impact of gastrectomy in older patients with gastric cancer.Methods: A series of 234 patients aged ≥ 80 years with histologically confirmed gastric cancer had indications for surgical treatment at the Gastroenterological Center, Yokohama City University Medical Center between April 2002 and December 2018. Patients who: lost to follow-up (n=27), had tumors not eligible for surgery (n=14), and could not achieve R0 resection (n=7) were excluded from this retrospective study. The remaining 186 patients were included. Patient characteristics, intraoperative outcomes, postoperative complications, and long-term survival were evaluated.Results: The incidence of postoperative complications with Clavien–Dindo grade ≥II was observed in 61 patients (32.8%). The five-year relapse-free survival and overall survival (OS) rates were 84.2% and 63.4%, respectively. Multivariate analysis showed that geriatric nutritional risk index ( 2.36) (odds ratio, 1.94; 95% confidence interval, 1.02–3.67; p=0.043), and total gastrectomy (TG) (odds ratio, 1.97; p=0.042) significantly predicted postoperative complications. Moreover, TG (hazard ratio, 1.91; p=0.036) was an independent prognostic factor of OS. Conclusions: Poor immunonutritional status and TG led to worse short-term outcomes. Moreover, TG was an independent prognostic factor of OS in older patients with gastric cancer. It is necessary to provide effective perioperative care, including nutritional support, to clarify whether short-term outcomes would be improved.