Ann Surg Treat Res.  2016 Nov;91(5):219-225. 10.4174/astr.2016.91.5.219.

Comparison of survival of surgical resection and conservative treatment in patients with gastric cancer aged 80 years or older: a single-center experience

• Gong CS
• Yook JH
• Oh ST
• Kim BS

• KMID: 2356371
• DOI: http://doi.org/10.4174/astr.2016.91.5.219

Abstract

PURPOSE
With the increase in the average life expectancy, the elderly population continues to increase rapidly. However, no consensus has been reached on the feasibility for surgical resection due to the high morbidity and mortality rate after surgical treatment in elderly patients caused by aging and underlying diseases.
METHODS
This study was performed with patients aged 80 years and older. The subjects were classified into 2 groups as follows: the surgical resection group consisting of 61 patients, and the conservative treatment group consisting of 39 patients suitable for curative resection.
RESULTS
Mean age and clinical stages in the conservative treatment group were higher than those in the surgical resection group. There was no significant difference in sex, location of the lesion, histological type, or underlying disease. The mean survival time of surgical resection group and conservative treatment group was respectively 52.1 ± 2.66 months and 37.1 ± 5.08 months (P < 0.05) for clinical stage 1 disease, 41.7 ± 5.16 months and 22.4 ± 6.07 months (P = 0.004) for stage 2 disease, and 31.7 ± 9.37 months and 10.6 ± 1.80 months (P = 0.049) for stage 3 disease. However, as for the extent of lymph node resection for the different stages, we observed no significant difference between the 2 groups.
CONCLUSION
Surgical resection in all clinical stages, except stage 4, showed a higher survival rate than conservative treatment. To minimize postoperative surgery complications, limited lymph node dissection should also be considered.

Keyword

Stomach neoplasms; 80 and over aged; Mortality

MeSH Terms

Aged
Aging
Consensus
Humans
Life Expectancy
Lymph Node Excision
Lymph Nodes
Mortality
Stomach Neoplasms*
Survival Rate

Figure

• 

  Fig. 1 Kaplan-Meier overall survival curves for the group of surgical resection and conservative treatment (observation). Panel A shows the statistically significant difference of clinical stage I gastric cancer between surgical resection group and conservative treatment group. Panel B shows the statistically significant difference of clinical stage II gastric cancer between surgical resection group and conservative treatment group. Panel C shows the statistically significant difference of clinical stage III gastric cancer between surgical resection group and conservative treatment group. P-values are calculated by the log-rank test.

• 

  Fig. 2 For the surgical resection group alone, Kaplan-Meier overall survival curves of D1 (D1, D1+) and D2 (D2, D2+). D0 dissection patients were excluded in analysis. Panel A shows no significant difference of the clinical stage I between D1 and D2 node dissection. Panel B shows no significant difference of the clinical stage II between D1 and D2 node dissection. Panel C shows no significant difference of the clinical stage III between D1 and D2 node dissection. P-values are calculated by the log-rank test.

• 

  Fig. 3 Subgroup analysis of overall survival for the surgical resection group and conservative treatment group. HR, hazard ratio; CI, confidence interval.

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