Total gastrectomy with "over-D1" lymph node dissection: what is the actual impact of age?
BACKGROUND
We aimed to evaluate risk factors for postoperative complications after total gastrectomy with "over-D1" lymphadenectomy.


METHODS
Data on 161 patients (54 cases aged >75 years: elderly group) operated on between 2005 and 2011 were reviewed. Risk factors analyzed for complications (Clavien-Dindo classification) included sex, age, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), pTNM stage, long-term antiplatelets therapy, operative time, and splenectomy.


RESULTS
The median age of the study population was 71 (interquartile range [IQR] 62-77) years (79 [range 76-90] years for elderly patients vs 65 [range 33-75] years for the control group, P < .0001). ASA classification was the only baseline characteristic significantly different in the intergroup analysis; 79.6% of the elderly patients were in ASA class III to IV versus 39.2% of the controls (P < .0001). Univariate analysis showed that patient age, ASA score, BMI, and splenectomy were predictive of postoperative complications. Multivariate analysis confirmed ASA score and splenectomy as independent risk-factors.


CONCLUSIONS
Regardless of age, fit elderly patients with operable gastric cancer should be candidates for the recommended standard extensive surgical resection provided that pre-existing comorbidities are considered.
Department of Medical and Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy. giacomopata@alice.it
Giacomo
G
Pata
Leonardo
L
Solaini
Stefano
S
Roncali
Mario
M
Pasini
Fulvio
F
Ragni
D000005:Abdomen; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D013909:Thorax; D016896:Treatment Outcome