title: Less-invasive surgery for gastric cancer prolongs survival in patients over 80 years of age.
abstract: This study was undertaken to determine the most appropriate form of surgery for elderly patients with gastric cancer in relation to postoperative complications and long-term survival. A total of 72 consecutive patients over 80 years of age who underwent partial or total gastrectomy were evaluated using an E-PASS scoring system. This system is comprised of a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) determined by both the PRS and SSS. Patients with a CRS > or = 0.5 had significantly higher rates of morbidity and mortality at 45.0% and 20.0%, respectively, than those with CRS < or = 0.5, at 17.0% and 2.1%, respectively. A Cox regression analysis of long-term survival, including death from other causes, identified five significant prognostic factors, namely: stage, curability, SSS, CRS, and allogeneic blood transfusion. Among the patients without any apparent residual cancer, a significantly better survival was seen in those who underwent less invasive surgery (SSS < 0.25), those with a CRS < or = 0.5, and those who had not been given a blood transfusion. These results suggest that less invasive surgery not requiring a blood transfusion is advisable for patients over 80 years of age with gastric cancer. Furthermore, gastrectomy with a CRS > or = 0.5 may have a poor therapeutic effect on both early and long-term outcome.
authors.affiliation: Department of Surgery II, Kumamoto University Medical School, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Haga
authors.forename: Y
authors.initials: Y
authors.lastname: Yagi
authors.forename: M
authors.initials: M
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D013505:Digestive System Surgical Procedures / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D013312:Stress, Physiological / Q000401:mortality