Postoperative complications and overall survival in elderly patients with gastric cancer: A retrospective study.

Abstract

336 Background: Japan is one of the fastest-aging countries in the world, and the number of elderly patients undergoing surgery for gastric cancer is increasing. Because of a higher prevalence of comorbidities, decreased physiological reserve, and reduced functional capacity, elderly patients are generally more prone to postoperative complications. Postoperative complications are widely recognized as poor prognostic factors in gastric cancer patients; however, their prognostic impact in elderly patients remains unclear. This study aimed to evaluate the association between postoperative complications and overall survival (OS) in patients aged 80 years or older. Methods: We retrospectively analyzed 61 patients aged 80 years or older who underwent gastrectomy with D2 lymph node dissection between 1999 and 2020. Postoperative complications were categorized according to the Clavien-Dindo (CD) classification into “minor complication group” (CD Grade ≤ II, including no postoperative complications) and “major complication group” (CD Grade ≥ III), and the impact of postoperative complications on OS was assessed. Multivariate analysis included postoperative complications and pathological stage (pStage). A subgroup analysis excluding macroscopic type 4 tumors was also performed. Results: Postoperative complications occurred in 24 patients (39.3%), including 8 patients (13.1%) with major complications. The major complication group had a significantly longer postoperative hospital stay (median 33 days vs. 14 days, P = 0.011), while other baseline characteristics were similar between groups. Non-cancer-related deaths were significantly higher in the major complication group (50.0% vs 13.1%, P = 0.041). Kaplan–Meier analysis showed a trend toward worse OS in the major complication group (P = 0.063). In multivariate analysis, major complications (CD grade ≥ III) were identified as an independent prognostic factor for OS (HR 2.51; 95% CI 1.01–6.24; P = 0.049), showing a stronger impact on prognosis than pStage (HR 1.62; 95% CI 0.79–3.31; P = 0.187). In the subgroup excluding macroscopic type 4 tumors, only major complications (CD grade ≥ III) had a significant impact on OS (P = 0.044). Conclusions: In gastric cancer patients aged 80 years or older, major postoperative complications (CD grade ≥ III) had a stronger impact on OS than pStage. In elderly patients, prevention of postoperative complications is important, given their heightened physiological vulnerability and the potential impact on long-term outcomes.