The Present Status and Problems Regarding the Treatment for Extremely Elderly Gastric Cancer Patients

Abstract

The pros and cons of gastrectomy for extremely elderly gastric cancer patients are not clear. We clarified the real clinical practice for gastric cancer patients with 85 years or older (EEGC) and examined the short and long-term results of gastrectomy in these patients. ①We analyzed 208 EEGC patients who visited our hospital. There were 36 patients who underwent surgery, 71 patients who had endoscopic submucosal resection (ESD), 23 chemotherapy patients, 28 cases who received best supportive care, and 68 patients who did not receive any treatment. Four non-curative ESD cases did not undergo additional gastrectomy. Gastrectomy was not performed for 23 patients with advanced gastric cancer and 30 patients with early gastric cancer due to dementia, comorbidity, poor PS, patient refusal, doctor’s decision and so on. ②We analyzed 46 EEGC gastrectomy patients regarding their characteristics and short and long-term results. Thirty-eight patients had preoperative comorbidities such as cardiovascular disease (58.7％), history of malignant tumor (21.7％), respiratory disease (17.4％), and so on. Reduced surgery for lymph adenectomy and gastrectomy area were often performed. Postoperative complications occurred in 20 cases. One patient died within 30 days after surgery. The 3-year survival rates were 34.1％ overall, and 62.5％ in pStage Ⅰ patients. All causes of death in pStage Ⅰ were other diseases. In conclusion, gastrectomy for EEGC patients was often avoided due to comorbidity and balance of surgery effectiveness. Even if it was possible to overcome the perioperative period for gastrectomy, we could not find the data affirming aggressive surgical treatment in terms of the prognosis.