title: Predictors of postoperative complications in elderly and oldest old patients with gastric cancer.
abstract: BACKGROUND
  The incidence of gastric cancer has been increasing among elderly persons in Japan. This study aimed to clarify risk factors for postoperative complications in oldest old patients with gastric cancer.
  
  
  METHODS
  One-hundred ninety patients more than 75 years old with gastric cancer underwent gastrectomy between 2000 and 2011. Patients were classified into two groups: group A included 29 patients who were 85 years or older (oldest old patients), and group B included 161 patients who were 75-84 years of age. Perioperative parameters associated with complications were compared in each group.
  
  
  RESULTS
  The preoperative estimated glomerular filtration rate was significantly lower in group A (p = 0.03). The two groups significantly differed in performance status (p = 0.018). Patients in group A received a lesser extent of lymph node dissection and had fewer lymph nodes excised. As a result, the duration of the operation was significantly shorter in group A. There were no significant differences in the frequency or grade of total complications or mortality between the two groups. Operative hemorrhage (>300 ml) and Hiroshima POSSUM (predicted morbidity risk >40) were risk factors in both groups A and B; the risk factors of preoperative serum albumin level and prognostic nutritional index (PNI) were specific to group A.
  
  
  CONCLUSIONS
  Adjustments to the extent of surgery among oldest old patients most likely reduces the incidence of postoperative complications in this group. Preoperative serum albumin level and PNI are significant predictors of postoperative complications in oldest old patients with gastric cancer.
authors.affiliation: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Takama
authors.forename: Keiichi
authors.initials: K
authors.lastname: Okano
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kondo
authors.forename: Shintaro
authors.initials: S
authors.lastname: Akamoto
authors.forename: Masao
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Hisashi
authors.initials: H
authors.lastname: Usuki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D005919:Glomerular Filtration Rate; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate