Gastrectomy with limited surgery for elderly patients with gastric cancer.
OBJECTIVE
Elderly patients with gastric cancer can receive standard gastrectomy or gastrectomy with reduced nodal dissection, i.e., limited surgery, in order to prevent postoperative complications. This study evaluated the feasibility of gastrectomy with limited surgery for elderly patients with gastric cancer.


METHODS
A total of 267 elderly patients (≥70 years old) were divided into two groups according to the level of nodal dissection: patients who received nodal dissection according to guidelines were included in the standard surgery group (standard group), and those who received reduced nodal dissection were included in the limited surgery group (limited group). The surgical outcomes of the two groups were compared.


RESULTS
There were 170 patients in the standard group and 97 patients in the limited group. The limited group had significantly poorer nutrition status and a significantly higher proportion with comorbidities. Morbidity and mortality were similar in both groups. Multivariate analysis showed that the overall survival rates were significantly worse in patients with advanced age, male gender, low body mass index, low prognostic nutrition index, and higher tumor stage. The disease-specific survival rate was significantly lower in the limited group than in the standard group (p<0.001).


CONCLUSIONS
Gastrectomy according to the gastric treatment guidelines for elderly patients with gastric cancer is recommended. Elderly male patients with poor nutrition have poor prognosis; prognostic nutrition index <40. Limited surgery is a treatment option for such patients.
Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan. Electronic address: mikamikj@fukuoka-u.ac.jp.
Koji
K
Mikami
Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan.
Kimikazu
K
Hirano
Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan.
Kitarou
K
Futami
Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino City, Fukuoka 818-8502, Japan.
Takafumi
T
Maekawa
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
elderly patients; gastric cancer; limited surgery; lymph node dissection; prognostic nutrition index