title: Decisions for extent of gastric surgery in gastric cancer patients: younger patients require more attention than the elderly.
abstract: OBJECTIVE
  There is a prevailing belief that young patients with gastric adenocarcinomas have a more aggressive disease.
  
  
  METHODS
  We reviewed the prospectively collected database of 753 gastric adenocarcinomas patients who had undergone curative gastrectomy. Clinicopathological factors and the survival rates for each pathological TNM stage were compared between patients younger than 40 years of age and the others.
  
  
  RESULTS
  Fifty-four (9.8%) patients were younger than 40 years of age. The overall accuracy of the intra-operative stage was 62.5%; 54.0% in the young patients and 63.5% in older patients (P = 0.006). Intraoperative under-staging was more commonly seen in the younger patients when compared to the older patients. These trends were more prominent in patients with surgical stage I disease. Age proved to be an independent risk factor influencing the accuracy of intraoperative staging using a logistic regression analysis. There was no difference in overall 3-year survival rate between the two age groups for each pathological TNM stage.
  
  
  CONCLUSIONS
  The present study showed that intra-operative under-staging was more common in young patients with gastric cancer, especially with stage I disease. This finding raises the concern for inaccurate diagnosis and surgical under treatment in younger patients with stage I gastric cancer.
authors.affiliation: Center for Gastric Cancer, National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea.
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Keun Won
authors.initials: KW
authors.lastname: Ryu
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Jong Ryeol
authors.initials: JR
authors.lastname: Lee
authors.forename: Chan Gyoo
authors.initials: CG
authors.lastname: Kim
authors.forename: Il Ju
authors.initials: IJ
authors.lastname: Choi
authors.forename: Sook Ryun
authors.initials: SR
authors.lastname: Park
authors.forename: Myeong-Cherl
authors.initials: MC
authors.lastname: Kook
authors.forename: Young-Woo
authors.initials: YW
authors.lastname: Kim
authors.forename: Jae-Moon
authors.initials: JM
authors.lastname: Bae
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome