Surgical Management of Gastric Cancer in Elderly Patients: Results of a Multicenter Cohort of the French Surgical Association

Abstract

Background: Gastric cancer primarily affects the elderly, but surgical management varies with age. This multicenter, retrospective cohort study assessed treatment approaches and outcomes in patients with gastric cancer based on age.

Study design: Between 2007 and 2017, 2,131 patients treated in French Surgical Association centers were identified. Patients with metastatic disease, those who did not undergo gastrectomy, those who underwent emergency surgery, those who underwent hyperthermic intraperitoneal chemotherapy, and those with unspecified birth dates were excluded. The final cohort of 1,426 patients was divided into 3 age groups: younger than 70 years (group 1, 60%), 70 to 79 years (group 2, 27%), and 80 years or older (group 3, 13%).

Results: Elderly patients were more often women and received less neoadjuvant chemotherapy (58% vs 43% vs 17%, p < 0.001). Despite similar tumor locations, they underwent fewer total gastrectomies (68% vs 55% vs 43%, p < 0.001) and D2 dissections (22% vs 22% vs 12%, p = 0.007). Medical complications increased with age, whereas surgical complications were not significantly higher in group 3. Advanced age was not an independent risk factor for severe postoperative complications (Clavien-Dindo grade III or higher). Pathologic results were comparable, but elderly patients received less postoperative treatment (67% vs 45% vs 16%, p < 0.001). Five-year overall survival decreased with age (64% vs 52% vs 37%, p < 0.001), whereas cancer-specific survival remained stable (69% vs 67% vs 63%, p = 0.56).

Conclusions: Advanced age does not independently increase the risk of postoperative morbidity and should not justify less aggressive surgery. Despite receiving less perioperative treatment, selected elderly patients maintain a comparable cancer prognosis to younger individuals.