title: Surgery for gastric cancer patients of age 85 and older: Multicenter survey.
abstract: OBJECTIVE
  To investigate the surgical therapies for gastric cancer (GC) patients of age 85 or older in a multicenter survey.
  
  
  METHODS
  Therapeutic opportunities for elderly GC patients have expanded in conjunction with extended life expectancy. However, the number of cases encountered in a single institution is usually very small and surgical therapies for elderly GC patients have not yet been standardized completely. In the present study, a total of 134 GC patients of age 85 or older who underwent surgery in 9 related facilities were retrospectively investigated. The relationships between surgical therapies and clinicopathological or prognostic features were analyzed.
  
  
  RESULTS
  Eighty-nine of the patients (66%) presented with a comorbidity, and 26 (19% overall) presented with more than two comorbidities. Radical lymphadenectomy was performed in 59 patients (44%), and no patient received pre- or post-operative chemotherapy. Forty of the patients (30%) experienced perioperative complications, but no surgical or perioperative mortality occurred. Laparoscopic surgery was performed in only 12 of the patients (9.0%). Univariate and multivariate analyses of the 113 patients who underwent R0 or R1 resection identified the factors of pT3/4 and limited lymphadenectomy as predictive of worse prognosis (HR = 4.68,P= 0.02 and HR =2.19,P= 0.05, respectively). Non-cancer-specific death was more common in cStage I patients than in cStage II or III patients. Limited lymphadenectomy correlated with worse cancer-specific survival (P= 0.01), particularly in cStage II patients (P< 0.01). There were no relationships between limited lymphadenectomy and any comorbidities, except for cerebrovascular disease (P= 0.07).
  
  
  CONCLUSIONS
  Non-cancer-specific death was not negligible, particularly in cStage I, and gastrectomy with radical lymphadenectomy appears to be an effective treatment for cStage II elderly GC patients.
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itoh
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Fukuda
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kakihara
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Takemura
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Okugawa
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Uchiyama
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Nakata
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishi
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kosuga
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Hirotaka Konishi, Daisuke Ichikawa, Toshiyuki Kosuga, Shuhei Komatsu, Kazuma Okamoto, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan.
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000369:Aged, 80 and over; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008197:Lymph Node Excision; D008297:Male; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Elderly more than 85; Gastric cancer; Limited lymphadenectomy; Multicenter survey; Surgery