Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study

• Published in: European journal of surgical oncology 2016-12, Vol.42 (12), p.1881-1889
• Main Authors: Rausei, S, Ruspi, L, Rosa, F, Morgagni, P, Marrelli, D, Cossu, A, Cananzi, F.C.M, Lomonaco, R, Coniglio, A, Biondi, A, Cipollari, C, Graziosi, L, Fumagalli, U, Casella, F, Bertoli, P, di Leo, A, Alfieri, S, Vittimberga, G, Roviello, F, Orsenigo, E, Quagliuolo, V, Montemurro, S, Baiocchi, G, Persiani, R, Bencivenga, M, Donini, A, Rosati, R, Sansonetti, A, Ansaloni, L, Zanoni, A, Galli, F, Dionigi, G
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - epidemiology; Adenocarcinoma - surgery; Adult; Age Factors; Aged; Aged, 80 and over; Cardiovascular Diseases - epidemiology; Comorbidity; Dementia - epidemiology; Diabetes Mellitus - epidemiology; Disease-Free Survival; Elderly; Female; Gastrectomy - methods; Gastric cancer; Hematology, Oncology and Palliative Medicine; High morbidity; Humans; Liver Diseases - epidemiology; Lymph Node Excision - methods; Lymphadenectomy; Male; Middle Aged; Postoperative Complications - epidemiology; Pulmonary Disease, Chronic Obstructive - epidemiology; Retrospective Studies; Stomach Neoplasms - epidemiology; Stomach Neoplasms - surgery; Surgery; Survival Rate; Tailored treatment
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2016.05.003

Abstract Background Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p