Effect of age on surgical outcomes of extended gastrectomy with D2 lymph node dissection in gastric carcinoma: prospective cohort study.

BACKGROUND AND PURPOSE

As a life expectancy increases, the proportion of aged patients diagnosed with gastric cancer has increased over the past decades, but the optimal surgical approach to these patients remains a dilemma because of the presumed risk associated with extended surgery.

METHODS

A total of 383 consecutive patients who underwent gastrectomy with D2 lymph node dissection in 2008 and 2009 were enrolled onto this study. Patients were divided into two age groups (<70 vs. > or =70 years) and were prospectively evaluated with respect to postoperative complications and hospital courses.

RESULTS

The cohort consisted of 101 elderly and 282 nonelderly patients. No statistically significant differences were evident between the two groups with respect to clinicopathological parameters and operations performed, except for preoperative comorbidity rates and mean American Society of Anesthesiologists scores. Surgical complication rates in the elderly and nonelderly groups were 18.8 and 17.4%, respectively (P = 0.746), and medical complication rates were 5.0 and 1.8%, respectively (P = 0.137). The two groups were not statistically significantly different in terms of mean length of hospital stays, times to diet start, or required transfusion. Multivariate analysis showed that body mass index, male sex, and distal pancreatectomy were independent risk factors of a surgical complication, and that comorbidity and operating time were independently associated with a medical complication.

CONCLUSIONS

This study shows that age neither increased postoperative morbidity nor negatively affected hospital courses after gastrectomy with D2 lymph node dissection. Accordingly, chronologic age alone should not preclude standard gastrectomy with extended lymph node dissection in gastric carcinoma.