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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2015

01-12-2015 | Gastrointestinal Oncology

Outcomes of Gastric Cancer Resection in Octogenarians: A Multi-institutional Study of the U.S. Gastric Cancer Collaborative

Authors: Thuy B. Tran, MD, David J. Worhunsky, MD, Malcolm H. Squires III, MD, Linda X. Jin, MD, Gaya Spolverato, MD, Konstantinos I. Votanopoulos, MD, Carl Schmidt, MD, Sharon Weber, MD, Mark Bloomston, MD, Clifford S. Cho, MD, Edward A. Levine, MD, Ryan C. Fields, MD, Timothy M. Pawlik, MD, MPH, PhD, Shishir K. Maithel, MD, Jeffrey A. Norton, MD, George A. Poultsides, MD, MS, FACS

Published in: Annals of Surgical Oncology | Issue 13/2015

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Abstract

Background

As the U.S. population ages, an increasing number of elderly patients with gastric adenocarcinoma are being evaluated for surgical resection. This study aimed to describe the short- and long-term outcomes after gastric cancer resection for patients 80 years of age or older.

Methods

Patients who underwent gastrectomy for gastric adenocarcinoma from 2000 to 2012 at seven U.S. academic institutions were analyzed. The main outcome measures included postoperative morbidity, mortality, survival, and failure to rescue (defined as death after any complication).

Results

Of 953 patients who underwent distal or total gastrectomy during the 12-year study period, 127 (13 %) were 80 years of age or older. Although the type of postoperative complications did not differ between the two groups, octogenarians had a higher incidence of any (54 vs 41 %; p = 0.006) and of major (28 vs 17 %; p = 0.006) postoperative complications. This translated into higher 30-day (10.2 vs 3.6 %; p = 0.001) and 90-day mortality (19.7 vs 7.9 %; p = 0.001) rates, with correspondingly higher failure-to-rescue rates (17.4 vs 8 %; p = 0.015). However, disease-specific survival after resection was equivalent between the two groups (5-year survival: 46 vs 53 %; p = 0.676). In the multivariate analysis, age of 80 years or older, blood transfusion, and albumin and creatinine levels all were independent predictors of 90-day mortality. Stage, tumor grade, race, blood transfusion, and adjuvant therapy, but not age, were independently associated with disease-specific survival.

Conclusion

Perioperative mortality and failure-to-rescue from complications is substantial for octogenarians undergoing gastric cancer resection. However, if the operation can be performed safely, the long-term cancer-specific outcome appears similar to that for younger patients.
Literature
1.
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.CrossRefPubMed
2.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.CrossRefPubMed
3.
4.
Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.CrossRefPubMed
5.
Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–30.CrossRefPubMed
6.
Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012;30:2327–33.PubMedCentralCrossRefPubMed
7.
8.
Trimble EL, Christian MC. Cancer treatment and the older patient. Clin Cancer Res. 2006;12(7 Pt 1):1956–7.CrossRefPubMed
9.
United Nations, Department of Economic and Social Affairs, Population Division. World population ageing, 1950–2050. United Nations, New York, 2002.
10.
11.
12.
Morel P, Egeli RA, Wachtl S, Rohner A. Results of operative treatment of gastrointestinal tract tumors in patients over 80 years of age. Arch Surg. 1989;124:662–4.CrossRefPubMed
13.
14.
Ziffren SE. Comparison of mortality rates for various surgical operations according to age groups, 1951–1977. J Am Geriatr Soc. 1979;27:433–8.CrossRefPubMed
15.
16.
Biondi A, Cananzi FC, Persiani R, et al. The road to curative surgery in gastric cancer treatment: a different path in the elderly? J Am Coll Surg. 2012;215:858–67.CrossRefPubMed
17.
Coniglio A, Tiberio GA, Busti M, et al. Surgical treatment for gastric carcinoma in the elderly. J Surg Oncol. 2004;88:201–5.CrossRefPubMed
18.
Katai H, Sasako M, Sano T, Fukagawa T. Gastric cancer surgery in the elderly without operative mortality. Surg Oncol. 2004;13:235–8.CrossRefPubMed
19.
Orsenigo E, Tomajer V, Palo SD, et al. Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer. 2007;10:39–44.CrossRefPubMed
20.
21.
Takeshita H, Ichikawa D, Komatsu S, et al. Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg. 2013;37:2891–8.CrossRefPubMed
22.
Saidi RF, Bell JL, Dudrick PS. Surgical resection for gastric cancer in elderly patients: is there a difference in outcome? J Surg Res. 2004;118:15–20.CrossRefPubMed
23.
Bittner R, Butters M, Ulrich M, Uppenbrink S, Beger HG. Total gastrectomy: updated operative mortality and long-term survival with particular reference to patients older than 70 years of age. Ann Surg. 1996;224:37–42.PubMedCentralCrossRefPubMed
24.
Bartlett EK, Roses RE, Kelz RR, Drebin JA, Fraker DL, Karakousis GC. Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database. Surgery. 2014;156:298–304.CrossRefPubMed
25.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.CrossRefPubMed
26.
Edge SB, American Joint Committee on Cancer, American Cancer Society. AJCC cancer staging manual. 7th ed. New York: Springer, 2010.
27.
Sheetz KH, Krell RW, Englesbe MJ, Birkmeyer JD, Campbell DA Jr, Ghaferi AA. The importance of the first complication: understanding failure to rescue after emergent surgery in the elderly. J Am Coll Surg. 2014;219:365–70.PubMedCentralCrossRefPubMed
28.
Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and patient characteristics associated with death after surgery: a study of adverse occurrence and failure to rescue. Med Care. 1992;30:615–29.CrossRefPubMed
29.
Gajdos C, Kile D, Hawn MT, Finlayson E, Henderson WG, Robinson TN. Advancing age and 30-day adverse outcomes after nonemergent general surgeries. J Am Geriatr Soc. 2013;61:1608–14.PubMedCentralCrossRefPubMed
30.
Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg. 2009;250:1029–34.CrossRefPubMed
31.
Kattan MW, Karpeh MS, Mazumdar M, Brennan MF. Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol. 2003;21:3647–50.CrossRefPubMed
32.
Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 2010;251:640–6.CrossRefPubMed
33.
Noguchi Y, Yoshikawa T, Tsuburaya A, Motohashi H, Karpeh MS, Brennan MF. Is gastric carcinoma different between Japan and the United States? Cancer. 2000;89:2237–46.CrossRefPubMed
34.
Scurtu R, Bachellier P, Oussoultzoglou E, Rosso E, Maroni R, Jaeck D. Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg. 2006;10:813–22.CrossRefPubMed
35.
Ghaferi AA, Osborne NH, Birkmeyer JD, Dimick JB. Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg. 2010;211:325–30.CrossRefPubMed
36.
Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003;138:721–5; discussion 726.CrossRefPubMed
37.
Wright JD, Herzog TJ, Siddiq Z, et al. Failure to rescue as a source of variation in hospital mortality for ovarian cancer. J Clin Oncol. 2012;30:3976–82.CrossRefPubMed
38.
Wainess RM, Dimick JB, Upchurch GR Jr, Cowan JA, Mulholland MW. Epidemiology of surgically treated gastric cancer in the United States, 1988–2000. J Gastrointest Surg. 2003;7:879–83.PubMed
39.
Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210:901–8.CrossRefPubMed
40.
Ingraham AM, Cohen ME, Bilimoria KY, et al. Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement. Surgery. 2010;148:217–38.CrossRefPubMed
41.
Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–9.CrossRefPubMed
42.
Scarborough JE, Pappas TN, Bennett KM, Lagoo-Deenadayalan S. Failure-to-pursue rescue: explaining excess mortality in elderly emergency general surgical patients with preexisting “do-not-resuscitate” orders. Ann Surg. 2012;256:453–61.CrossRefPubMed
43.
Sheetz KH, Waits SA, Krell RW, Campbell DA Jr, Englesbe MJ, Ghaferi AA. Improving mortality following emergent surgery in older patients requires focus on complication rescue. Ann Surg. 2013;258:614–7; discussion 617–8.PubMedCentralPubMed
44.
Sohn TA, Yeo CJ, Cameron JL, et al. Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg. 1998;2:207–16.CrossRefPubMed
45.
Haigh PI, Bilimoria KY, DiFronzo LA. Early postoperative outcomes after pancreaticoduodenectomy in the elderly. Arch Surg. 2011;146:715–23.CrossRefPubMed
46.
Lightner AM, Glasgow RE, Jordan TH, et al. Pancreatic resection in the elderly. J Am Coll Surg. 2004;198:697–706.CrossRefPubMed
47.
Markar SR, Karthikesalingam A, Thrumurthy S, Ho A, Muallem G, Low DE. Systematic review and pooled analysis assessing the association between elderly age and outcome following surgical resection of esophageal malignancy. Dis Esophagus. 2013;26:250–62.CrossRefPubMed
48.
Fong Y, Blumgart LH, Fortner JG, Brennan MF. Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg. 1995;222:426–34.PubMedCentralCrossRefPubMed
49.
Reid-Lombardo KM, Gay G, Patel-Parekh L, Ajani JA, Donohue JH. Treatment of gastric adenocarcinoma may differ among hospital types in the United States, a report from the National Cancer Data Base. J Gastrointest Surg. 2007;11:410–19; discussion 419–20.PubMedCentralCrossRefPubMed
50.
Enzinger PC, Benedetti JK, Meyerhardt JA, et al. Impact of hospital volume on recurrence and survival after surgery for gastric cancer. Ann Surg. 2007;245:426–34.PubMedCentralCrossRefPubMed
Metadata
Title
Outcomes of Gastric Cancer Resection in Octogenarians: A Multi-institutional Study of the U.S. Gastric Cancer Collaborative
Authors
Thuy B. Tran, MD
David J. Worhunsky, MD
Malcolm H. Squires III, MD
Linda X. Jin, MD
Gaya Spolverato, MD
Konstantinos I. Votanopoulos, MD
Carl Schmidt, MD
Sharon Weber, MD
Mark Bloomston, MD
Clifford S. Cho, MD
Edward A. Levine, MD
Ryan C. Fields, MD
Timothy M. Pawlik, MD, MPH, PhD
Shishir K. Maithel, MD
Jeffrey A. Norton, MD
George A. Poultsides, MD, MS, FACS
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4530-3

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