title: The road to curative surgery in gastric cancer treatment: a different path in the elderly?
abstract: BACKGROUND
  The aim of this study was to evaluate the possibility of a different path to achieve curative surgery in patients older than age 70 years and affected by resectable gastric cancer.
  
  
  METHODS
  This is a multicentric retrospective study based on an analysis of 1,465 patients with gastric adenocarcinoma who underwent surgery with curative intent. Patients were divided into 2 age groups (younger than 70 years vs older than 70 years) and were evaluated with respect to postoperative morbidity and mortality and survival.
  
  
  RESULTS
  Postoperative morbidity and mortality in elderly and nonelderly groups were 24.8% vs 20.6% and 2.6% vs 3.7%, respectively (p = NS). In the elderly group, multivisceral resection was independently associated with surgical complications (hazard ratio [HR] = 1.988; 95% CI, 1.124-3.516; p = 0.018), total gastrectomy with medical complications (HR = 2.007; 95% CI, 1.165-3.459; p = 0.012), and higher postoperative mortality (HR = 4.319; 95% CI, 1.571-11.873; p = 0.005); D1 lymph node dissection was predictive of a lower postoperative mortality rate (HR = 0.219; 95% CI, 0.080-0.603; p = 0.003). Five-year overall survival rates differed significantly in young and elderly patients (58.9% vs 38.9%; p < 0.001), and 5-year cancer-specific survival did not show any significant difference.
  
  
  CONCLUSIONS
  Age should not be considered as a factor in the selection of treatment for gastric cancer patients. Curative surgery can be performed as safely in elderly patients as in younger patients, with comparable postoperative results and long-term survival rates, although the life expectancy of elderly patients is shorter.
authors.affiliation: General Surgery Unit, Department of Surgery, A. Gemelli University Hospital, Catholic University of Rome, Largo A. Gemelli 8, Rome, Italy. biondi.alberto@tiscali.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Biondi
authors.forename: Ferdinando C M
authors.initials: FC
authors.lastname: Cananzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Persiani
authors.forename: Valerio
authors.initials: V
authors.lastname: Papa
authors.forename: Maurizio
authors.initials: M
authors.lastname: Degiuli
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Doglietto
authors.forename: Domenico
authors.initials: D
authors.lastname: D'Ugo
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D055815:Young Adult