J Gastric Cancer.  2019 Jun;19(2):202-211. 10.5230/jgc.2019.19.e16.

Extremely High Mortality Rate after a Successful Gastrectomy for Cancer in Older Adults

• Ciesielski M
• Kruszewski WJ
• Szajewski
• Walczak J
• Spychalska N
• Szefel J
• ZieliÅ„ski J

• KMID: 2449941
• DOI: http://doi.org/10.5230/jgc.2019.19.e16

Abstract

PURPOSE
Poor physiological reserve for withstanding major cancer surgery in older adults is an important concern in the selection of patients for oncologic gastrectomy. The present study aimed to analyze mortality patterns among patients who underwent gastrectomy for cancer according to age groups. The primary outcomes of this study were early- and middle-term results: 30-day and 3-, 6-, 12-, and 36-month mortality rates.
MATERIALS AND METHODS
A retrospective review of 288 patients who underwent surgical resection for gastric cancer in two centers was carried out. Patients were stratified into four groups according to age: 29-50 years (group I, n=27), 51-65 years (group II, n=117), 66-75 years (group III, n=81), and 76-92 years (group IV, n=58). Statistical calculations focused on the differences in the survival rates between groups I and II as well as between groups II and IV.
RESULTS
The middle-aged patients (group II) had significantly better 3-year survival than either the youngest (group I) or the oldest patients (group IV). The 6-month mortality rates were 16.9% in group III and 29.3% in group IV. Two-thirds of the patients from groups III and IV who died between 2 and 6 months after surgery had an uneventful postoperative course.
CONCLUSIONS
Age is an important prognostic factor of middle-term survival after gastrectomy for cancer. Geriatric assessment and better patient selection for major surgery for cancer are required to improve the outcome of gastrectomy for cancer in patients aged over 75 years.

Keyword

Stomach neoplasms; Gastrectomy; Aged; Geriatrics; Mortality

MeSH Terms

Adult*
Gastrectomy*
Geriatric Assessment
Geriatrics
Humans
Mortality*
Patient Selection
Retrospective Studies
Stomach Neoplasms
Survival Rate

Figure

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  Fig. 1 Mortality rates according to age subgroups.

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  Fig. 2 Overall survival in the four groups of patients in terms of age (P<0.001).

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  Fig. 3 (A) Comparison of the 5-year survival of group I and patients aged between 51 and 55 years (P=0.09). (B) Comparison of the 3-year survival of group I and patients aged between 51 and 55 years (P=0.02).

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  Fig. 4 Comparison of the overall survival of patients who lived at least 12 months after gastric resection in groups II and IV (P=0.16).

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