title: Severity of complications after gastrectomy in elderly patients with gastric cancer.
abstract: BACKGROUND
  The risk of surgery for gastric cancer has not been fully evaluated, and this study aimed to assess the severity of postoperative complications after D2 or modified D2 gastrectomy in elderly patients.
  
  
  METHODS
  Eligible patients were retrospectively selected from the Kanagawa Cancer Center database between 1990 and 2009 based on the following criteria: age ≥80 years and D2 or modified D2 gastrectomy as a primary treatment for gastric cancer. The severity of complications was evaluated using the Clavien-Dindo classification.
  
  
  RESULTS
  A total of 83 patients with a median age of 82 years (range 80-88 years) were entered in this study. Sixty (72 %) had at least one co-morbid condition. American Society of Anesthesiologists scores were 2 in 66 patients and 3 in 17 patients. The extent of gastrectomy was distal in 65 (78 %) and total in 18 (22 %) patients. The procedure used for lymphadenectomy was modified D2 in 38 (46 %) and D2 in 45 (54 %) patients. Altogether, 18 complications were observed in 15 patients. The overall morbidity rate was 18 % [95 % confidence interval (CI) 9.7-26.2 %], and the mortality rate was 3.6 % (95 % CI 0-7.6 %). Complications were classified as grade 2 (n = 9), grade 3a (n = 1), grade 3b (n = 4), grade 4 (n = 1), and grade 5 (n = 3). Severe complications (≥ grade 3) occurred in 8.4 % (95 % CI 2.4-14.4 %).
  
  
  CONCLUSIONS
  The morbidity rate was acceptable, but that of severe complications was high, suggesting that surgery for gastric cancer in elderly patients is risky and should be limited.
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama 241-0815, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hayashi
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogata
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Cho
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuburaya
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*