Outcomes of Gastric Cancer Resection in Octogenarians

A Multi-institutional Study of the U.S. Gastric Cancer Collaborative

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)4371-4379
Number of pages9
JournalAnnals of Surgical Oncology
Volume22
Issue number13
DOIs
StatePublished - Dec 1 2015

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Stomach Neoplasms
Survival
Mortality
Gastrectomy
Blood Transfusion
Stomach
Adenocarcinoma
Albumins
Creatinine
Neoplasms
Multivariate Analysis
Outcome Assessment (Health Care)
Morbidity
Incidence
Population
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Tran, T. B., Worhunsky, D. J., Squires, M. H., Jin, L. X., Spolverato, G., Votanopoulos, K. I., ... Poultsides, G. A. (2015). Outcomes of Gastric Cancer Resection in Octogenarians: A Multi-institutional Study of the U.S. Gastric Cancer Collaborative. Annals of Surgical Oncology, 22(13), 4371-4379. https://doi.org/10.1245/s10434-015-4530-3

Outcomes of Gastric Cancer Resection in Octogenarians : A Multi-institutional Study of the U.S. Gastric Cancer Collaborative. / Tran, Thuy B.; Worhunsky, David J.; Squires, Malcolm H.; Jin, Linda X.; Spolverato, Gaya; Votanopoulos, Konstantinos I.; Schmidt, Carl; Weber, Sharon; Bloomston, Mark; Cho, Clifford S.; Levine, Edward A.; Fields, Ryan C.; Pawlik, Timothy M.; Maithel, Shishir K.; Norton, Jeffrey A.; Poultsides, George A.

In: Annals of Surgical Oncology, Vol. 22, No. 13, 01.12.2015, p. 4371-4379.

Research output: Contribution to journalArticle

Tran, TB, Worhunsky, DJ, Squires, MH, Jin, LX, Spolverato, G, Votanopoulos, KI, Schmidt, C, Weber, S, Bloomston, M, Cho, CS, Levine, EA, Fields, RC, Pawlik, TM, Maithel, SK, Norton, JA & Poultsides, GA 2015, 'Outcomes of Gastric Cancer Resection in Octogenarians: A Multi-institutional Study of the U.S. Gastric Cancer Collaborative', Annals of Surgical Oncology, vol. 22, no. 13, pp. 4371-4379. https://doi.org/10.1245/s10434-015-4530-3
Tran, Thuy B. ; Worhunsky, David J. ; Squires, Malcolm H. ; Jin, Linda X. ; Spolverato, Gaya ; Votanopoulos, Konstantinos I. ; Schmidt, Carl ; Weber, Sharon ; Bloomston, Mark ; Cho, Clifford S. ; Levine, Edward A. ; Fields, Ryan C. ; Pawlik, Timothy M. ; Maithel, Shishir K. ; Norton, Jeffrey A. ; Poultsides, George A. / Outcomes of Gastric Cancer Resection in Octogenarians : A Multi-institutional Study of the U.S. Gastric Cancer Collaborative. In: Annals of Surgical Oncology. 2015 ; Vol. 22, No. 13. pp. 4371-4379.
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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.",
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T1 - Outcomes of Gastric Cancer Resection in Octogenarians

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AU - Tran, Thuy B.

AU - Worhunsky, David J.

AU - Squires, Malcolm H.

AU - Jin, Linda X.

AU - Spolverato, Gaya

AU - Votanopoulos, Konstantinos I.

AU - Schmidt, Carl

AU - Weber, Sharon

AU - Bloomston, Mark

AU - Cho, Clifford S.

AU - Levine, Edward A.

AU - Fields, Ryan C.

AU - Pawlik, Timothy M.

AU - Maithel, Shishir K.

AU - Norton, Jeffrey A.

AU - Poultsides, George A.

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N2 - 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.

AB - 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.

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