Predictors of postoperative complications in elderly and oldest old patients with gastric cancer

Background The incidence of gastric cancer has been increasing among elderly persons in Japan. This study aimed to clarify risk factors for postoperative complications in oldest old patients with gastric cancer. Methods One-hundred ninety patients more than 75 years old with gastric cancer underwent...

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Bibliographic Details
Published in:Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2015-07, Vol.18 (3), p.653-661
Main Authors: Takama, Takehiro, Okano, Keiichi, Kondo, Akihiro, Akamoto, Shintaro, Fujiwara, Masao, Usuki, Hisashi, Suzuki, Yasuyuki
Format: Article
Language:English
Subjects:
Abdominal Surgery
Aged
Aged, 80 and over
Blood Loss, Surgical
Cancer Research
Female
Gastrectomy - adverse effects
Gastric cancer
Gastroenterology
Glomerular Filtration Rate
Humans
Lymph Node Excision - adverse effects
Male
Medicine
Medicine & Public Health
Morbidity
Oncology
Original Article
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Risk Factors
Stomach Neoplasms - mortality
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgical Oncology
Survival Rate
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Summary:Background The incidence of gastric cancer has been increasing among elderly persons in Japan. This study aimed to clarify risk factors for postoperative complications in oldest old patients with gastric cancer. Methods One-hundred ninety patients more than 75 years old with gastric cancer underwent gastrectomy between 2000 and 2011. Patients were classified into two groups: group A included 29 patients who were 85 years or older (oldest old patients), and group B included 161 patients who were 75–84 years of age. Perioperative parameters associated with complications were compared in each group. Results The preoperative estimated glomerular filtration rate was significantly lower in group A ( p  = 0.03). The two groups significantly differed in performance status ( p  = 0.018). Patients in group A received a lesser extent of lymph node dissection and had fewer lymph nodes excised. As a result, the duration of the operation was significantly shorter in group A. There were no significant differences in the frequency or grade of total complications or mortality between the two groups. Operative hemorrhage (>300 ml) and Hiroshima POSSUM (predicted morbidity risk >40) were risk factors in both groups A and B; the risk factors of preoperative serum albumin level and prognostic nutritional index (PNI) were specific to group A. Conclusions Adjustments to the extent of surgery among oldest old patients most likely reduces the incidence of postoperative complications in this group. Preoperative serum albumin level and PNI are significant predictors of postoperative complications in oldest old patients with gastric cancer.
ISSN:1436-3291
1436-3305
DOI:10.1007/s10120-014-0387-6