Management, short and long-term outcomes in septegenerians and octegenerians undergoing gastrectomy for cancer

Aims: At present, the recommended treatment strategy in these pa- tients who present with gastric cancer is still controversial. We con- ducted a multicentre cohort study to assess the impact of age in gastric cancer management and outcomes. Methods: A retrospectively collected database demonstrated that 507 patients underwent gastrectomy for gastric adenocarcinoma from January 2004 to December 2014 at two high volume centres (London Royal Marsden Hospital and Verona University hospital). Patients were classified into three groups: Group A included all pa- tients aged 69 years old or less (n Z 266), Group B included 166 patients between 70e79 years (n Z 166), and Group C included pa- tients over 80 years and over (n Z 75). We analysed the data to eval- uate any differences between the groups in terms of patient characteristics, disease characteristics, treatment strategy, surgical outcome, overall survival and oncological outcome after gastrectomy. Results: Groups B and C were associated with a higher ASA and comorbidities (p < 0.001). They were less likely to receive peri-opera- tive chemotherapy (p Z 0.000). Group A presented with more advanced disease in terms of histological subtype (p Z 0.000) and increased metastatic burden (16.3%). In Groups B and C less aggres- sive surgery was performed. Group A had a higher rate of surgical complications (p Z 0.011). Group C demonstrated more medical com- plications (p Z 0.021). Group C had a higher postoperative mortality rate (8.1%, p Z 0.010). Using a Cox multivariable analysis, Group C (p Z 0.001) had a significantly less OS compared to A and B. Of note, DRS did not show significant differences in the three groups. Conclusions: Our data suggests that patients between the age of 70e79 years have a comparable OS risk as that of younger patients un- dergoing gastrectomy for gastric cancer. Patients over 80 years were found to have undergone less aggressive surgery and have more medical comorbidities. Their OS risk was higher. Elderly patients with gastric cancer should be rigorously assessed and medically optimised prior to undergoing surgical management in order to improve overall outcomes.