Gastric cancer surgery in the elderly without operative mortality

Background: Surgeons are increasingly being faced with the problem of treating elder gastric carcinoma patients. Recent improvements in the techniques for preoperative diagnosis and perioperative management have been made. The purpose of this study was to elucidate whether these improvements have produced a decrease in postoperative complications and mortality and resulted in a better clinical outcome. Methods: Between 1993 and 2003, 141 elderly patients (aged 80 years or above) with gastric cancer underwent operation under the care of dedicated staff surgeons. The results of treatment were analysed. Results: 52 (36.9%) patients had a diagnosis of gastric cancer during a health-check. Only 19 patients (13.5%) had no preoperative risk factors. The ASA score was II in 80%. Approximately 35% of the patients had early gastric cancer. Nodal metastasis was observed in 56% of the patients. The proportion of stage I patients was 40%. Resection rate was 95.7%. Reduced nodal dissection (<D2) was common (47%). The surgery-related complication rate was as low as 8% and the number of operation-related deaths was zero. The 3 (5) year survival rates were 59.0 (48.2-69.8), 48.8 (36.0-61.6) % overall, and 70.0 (58.3-81.7), 56.6 (41.4-71.8) % after curative resection. The 3 (5) year survival rate was 80.3 (63.9-96.7), 73.6 (54.0-93.2) % for early gastric cancer. Conclusions: Gastrectomy for elder patients can be carried out very safely by specialists with an excellent patient prognosis.