Is extended lymph node dissection necessary for gastric cancer in elderly patients?

OBJECTIVE

To compare the outcome after limited and extended gastric resections to find out whether extended lymph node dissection is indicated for gastric cancer in elderly patients.

DESIGN

Retrospective study.

SETTING

University hospital, Japan.

SUBJECTS

182 patients over 75 years of age with gastric cancer who had gastric resections from 1980 to 1995.

INTERVENTIONS

161 patients had limited lymph node dissection (limited group) and 21 had extended lymph node dissection (extended group).

MAIN OUTCOME MEASURES

Histopathological features, morbidity, mortality, and long-term survival.

RESULTS

Postoperative morbidity was 27% (n = 44) in the limited group and 57% (n = 12) in the extended group, and postoperative mortality was 1% (n = 2) in the limited group and 10% (n = 2) in the extended group; these differences are significant (p = 0.005 and p = 0.002). The 5-year survival did not differ significantly between the two groups. Only the T classification and presence of lymph node metastases had a significant influence on the outcome of gastric cancer in elderly patients.

CONCLUSIONS

The presence of lymph node metastases is a critical factor in the prognosis of gastric cancer, and extended lymph node dissection has therefore been recommended. However, extended lymph node dissection in elderly patients did not influence the 5-year survival; in addition, the mortality and morbidity in the extended group were higher than in the limited group. Extended lymph node dissection is therefore usually not indicated for gastric cancer in elderly patients.