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Cancer of the Stomach

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Surgical Management of Elderly Patients

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Abstract

Gastric cancer is considered one of the most frequent neoplasm of the old age with a peak in the seventh decade of life. Even if the overall incidence of gastric cancer has been reduced during the last decades, it is expected an increase number of new cases among old patients because of the elderly population is on rise. The clinicopathological features of gastric cancer in elderly patients are different from those of non-elderly patients: male predominance, localization in the lower third of the stomach, more histological differentiation, advanced TNM stage at the diagnosis. In elderly, as for young patients, surgical resection remains the only curative treatment. Preoperative comorbidities and the high risk of postoperative complications influence the surgical approach. For early gastric cancer, endoscopic resection is performed when there is no evidence of lymph node metastasis. For advanced cases, if feasible, performing a subtotal gastrectomy with limited lymphadenectomy offers a better quality of life and lower mortality rather than total gastrectomy associated to extended nodes dissection, with no significant difference in overall survival. After surgery, adjuvant chemotherapy should be determined by considering the conditions of individual patients and their life expectancies.

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References

  1. Zhu A, Sonnenberg A. Is gastric cancer again rising? J Clin Gastroenterol. 2012;46(9):804–6.

    Article  Google Scholar 

  2. [Internet]. Available from: http://www.registri-tumori.it/PDF/AIOM2016/I_numeri_del_cancro_2016.pdf.

  3. Nashimoto A, Akazawa K, Isobe Y, Miyashiro I, Katai H, Kodera Y, et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer. 2012;16(1):1–27.

    Article  Google Scholar 

  4. Moy K, Fan Y, Wang R, Gao Y, Yu M, Yuan J. Alcohol and tobacco use in relation to gastric cancer: a prospective study of men in shanghai, China. Cancer Epidemiol Biomark Prev. 2010;19(9):2287–97.

    Article  CAS  Google Scholar 

  5. Saif M, Makrilia N, Zalonis A, Merikas M, Syrigos K. Gastric cancer in the elderly: an overview. Eur J Surg Oncol. 2010;36(8):709–17.

    Article  CAS  Google Scholar 

  6. Kunisaki C, Akiyama H, Nomura M, Matsuda G, Otsuka Y, Ono H, et al. Comparison of surgical outcomes of gastric cancer in elderly and middle-aged patients. Am J Surg. 2006;191(2):216–24.

    Article  Google Scholar 

  7. Kim H, Kim J, Lim B, Kim H, Kim H, Park J, et al. Sex disparity in gastric cancer: female sex is a poor prognostic factor for advanced gastric cancer. Ann Surg Oncol. 2016;23(13):4344–51.

    Article  Google Scholar 

  8. Liang Y, Liang Y, Deng J, Guo H, Ding X, Wang X, Wang B, Zhang L, Liang H. Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years. World J Gastroenterol. 2013;19(39):6568.

    Article  Google Scholar 

  9. Uedo N, Takeuchi Y, Ishihara R. Endoscopic management of early gastric cancer: endoscopic mucosal resection or endoscopic submucosal dissection: data from a Japanese high-volume center and literature review. Ann Gastroenterol. 2012;25(4):281–90.

    PubMed  PubMed Central  Google Scholar 

  10. Arai T, Esaki Y, Inoshita N, Sawabe M, Kasahara I, Kuroiwa K, et al. Pathologic characteristics of gastric cancer in the elderly: a retrospective study of 994 surgical patients. Gastric Cancer. 2004;7(3):154–9.

    Article  Google Scholar 

  11. Fransen G, Janssen M, Muris J, Laheij R, Jansen J. Meta-analysis: the diagnostic value of alarm symptoms for upper gastrointestinal malignancy. Aliment Pharmacol Ther. 2004;20(10):1045–52.

    Article  CAS  Google Scholar 

  12. Pisanu A, Montisci A, Piu S, Uccheddu A. Curative surgery for gastric cancer in the elderly: treatment decisions, surgical morbidity, mortality, prognosis and quality of life. Tumori. 2007;93(5):478–84.

    Article  Google Scholar 

  13. Phoon R. Chronic kidney disease in the elderly - assessment and management. Aust Fam Physician. 2012;41(12):940–4.

    PubMed  Google Scholar 

  14. Takama T, Okano K, Kondo A, Akamoto S, Fujiwara M, Usuki H, et al. Predictors of postoperative complications in elderly and oldest old patients with gastric cancer. Gastric Cancer. 2014;18(3):653–61.

    Article  Google Scholar 

  15. Kim S, Brooks A, Groban L. Preoperative assessment of the older surgical patient: honing in on geriatric syndromes. Clin Interv Aging. 2015;10:13–27.

    PubMed  Google Scholar 

  16. Papanikolaou IS, Triantafyllou M, Triantafyllou K, Rösch T. EUS in the management of gastric cancer. Ann Gastroenterol Q Publ Hellenic Soc Gastroenterol. 2015;24(1):9–15.

    Google Scholar 

  17. Cho J. The role of Endosonography in the staging of gastrointestinal cancers. Clin Endosc. 2015;48(4):297.

    Article  Google Scholar 

  18. Puli S. How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review. World J Gastroenterol. 2008;14(25):4011.

    Article  Google Scholar 

  19. Holt B, Rösch T, Peter S. EUS in the evaluation of gastric tumors. In: Hawes RH, Fockens P, Varadarajulu S, editors. Endosonography. Philadelphia: Saunders; 2015. p. 129–50.

    Google Scholar 

  20. Kinkel K, Lu Y, Both M, Warren R, Thoeni R. Detection of hepatic metastasis from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis. Radiology. 2002;224(3):748–56.

    Article  Google Scholar 

  21. Kawanaka Y, Kitajima K, Fukushima K, Mouri M, Doi H, Oshima T, et al. Added value of pretreatment 18F-FDG PET/CT for staging of advanced gastric cancer: comparison with contrast-enhanced MDCT. Eur J Radiol. 2016;85(5):989–95.

    Article  Google Scholar 

  22. Orsenigo E, Tomajer V, Palo S, Carlucci M, Vignali A, Tamburini A, et al. Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer. 2007;10(1):39–44.

    Article  Google Scholar 

  23. Kang S, Kim H, Kim M. Low serum albumin level, male sex, and Total Gastrectomy are risk factors of severe postoperative complications in elderly gastric cancer patients. J Gastric Cancer. 2016;16(1):43.

    Article  Google Scholar 

  24. De Manzoni G, Roviello F, Siquini W. Surgery in the multimodal management of gastric cancer. 1st ed. Milan: Springer; 2012.

    Book  Google Scholar 

  25. Park H, Ahn J, Jung H, Lee J, Jung K, Kim D, et al. Clinical characteristics and outcomes of gastric cancer patients aged over 80 years: a retrospective case-control study. PLoS One. 2016;11(12):e0167615.

    Article  Google Scholar 

  26. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S. Endoscopic mucosal resection for treatment of early gastric cancer. Gut. 2001;48(2):225–9.

    Article  CAS  Google Scholar 

  27. Sakurai K, Muguruma K, Nagahara H, Kimura K, Toyokawa T, Amano R, et al. The outcome of surgical treatment for elderly patients with gastric carcinoma. J Surg Oncol. 2015;111(7):848–54.

    Article  Google Scholar 

  28. Wu C, Lo S, Shen K, Hsieh M, Lui W, P'eng F. Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg. 2000;24(4):465–72.

    Article  CAS  Google Scholar 

  29. Takeshita H, Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, et al. Surgical outcomes of Gastrectomy for elderly patients with gastric cancer. World J Surg. 2013;37(12):2891–8.

    Article  Google Scholar 

  30. Eguchi YT, Masahito IT. Is extended lymph node dissection necessary for gastric cancer in elderly patients? Eur J Surg. 2000;166(12):949–53.

    Article  CAS  Google Scholar 

  31. Rausei S, Ruspi L, Rosa F, Morgagni P, Marrelli D, Cossu A, et al. Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: a retrospective multicenter study. Eur J Surg Oncol. 2016;42(12):1881–9.

    Article  CAS  Google Scholar 

  32. Deiner SJ. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009;103(Supplement 1):i41–6.

    Article  Google Scholar 

  33. Field RR, Wall MH. Delirium: past, present, and future. Semin Cardiothorac Vasc Anesth. 2013 Sep;17(3):170–9.

    Article  Google Scholar 

  34. Yamada H, Kojima K, Inokuchi M, Kawano T, Sugihara K. Laparoscopy-assisted gastrectomy in patients older than 80. J Surg Res. 2010;161(2):259–63.

    Article  Google Scholar 

  35. Mikami K, Hirano K, Futami K, Maekawa T. Department of surgery, Fukuoka University Chikushi Hospital 1-1-1 Zokumyoin, Chikushino City, Fukuoka: Japan; p. 818–8502.

    Google Scholar 

  36. Saito H, Osaki T, Murakami D, Sakamoto T, Kanaji S, Tatebe S, Tsujitani S, Ikeguchi M. Effect of age on prognosis in patients with gastric cancer. ANZ J Surg. 2006;76:458–61.

    Article  Google Scholar 

  37. Sasada S, Ikeda Y, Saitsu H, Saku M. Characteristics of gastric cancer in patients over 80-years-old. Hepato-Gastroenterology. 2008;55(86–87):1931–4.

    PubMed  Google Scholar 

  38. Liu K, Wan J, Yu G, Bei Y, Chen X, Lu M. The recommended treatment strategy for locally advanced gastric cancer in elderly patients aged 75 years and older: a surveillance, epidemiology, and end results database analysis. J Cancer Res Clin Oncol. 2016;143(2):313–20.

    Article  Google Scholar 

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Authors and Affiliations

  1. Clinica Chirurgica—Ospedali Riuniti di Ancona, Ancona, Italy

    Roberto Vergari & Vanessa Polenta

  2. Formazione in Chirurgia Generale—Ospedali Riuniti di Ancona, Ancona, Italy

    Cristina Marmorale

  3. Direttrice della Scuola di Specialità in Chirurgia Generale—Università Politecnica delle Marche, Ancona, Italy

    Cristina Marmorale

Authors
  1. Roberto Vergari
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  2. Vanessa Polenta
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  3. Cristina Marmorale
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Corresponding author

Correspondence to Cristina Marmorale .

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Editors and Affiliations

  1. Department of General and Mininvasive Surgery, Cristo Re Hospital, Rome, Italy

    Antonio Crucitti

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Vergari, R., Polenta, V., Marmorale, C. (2018). Cancer of the Stomach. In: Crucitti, A. (eds) Surgical Management of Elderly Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-60861-7_11

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  • DOI: https://doi.org/10.1007/978-3-319-60861-7_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60860-0

  • Online ISBN: 978-3-319-60861-7

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