Gastric adenocarcinoma is considered a disease of the elderly, with a peak incidence in the seventh and eighth decades of life. In the elderly, biochemical changes in tissues and in organ physiology, in association with Helicobacter pylori infection, lead to atrophic gastritis, with an increased risk of developing cancer. Gastric cancer in the elderly is often diagnosed at an advanced stage and is associated with a poor prognosis in terms of disease-free and overall survival. Surgical treatment of gastric cancer in these patients remains controversial due to the increased perioperative risk; instead, subtotal gastrectomy is preferred when feasible. Total gastrectomy with or without combined resections of adjacent organs is associated with higher rates of postoperative morbidity and mortality. For advanced cancer, palliative resection is preferable, whenever possible, to gastroenterostomy. Morbidity and mortality are higher in the elderly, probably related to the comorbidities in these patients. T stage, lymph node metastases, and depth of invasion of the primary tumor are recognized as independent prognostic factors in terms of overall survival. The impact of multimodality treatment in the elderly cannot be clearly evaluated; currently, adjuvant chemotherapy is recommended in otherwise healthy patients. In general, age alone has not been definitively confirmed as a negative prognostic factor in patients with gastric cancer and should not preclude gastric resection. After radical resection, elderly patients have the same chance of survival as middle-age patients.

Surgical treatment of gastric cancer in elderly patients

Grossi U.;
2012

Abstract

Gastric adenocarcinoma is considered a disease of the elderly, with a peak incidence in the seventh and eighth decades of life. In the elderly, biochemical changes in tissues and in organ physiology, in association with Helicobacter pylori infection, lead to atrophic gastritis, with an increased risk of developing cancer. Gastric cancer in the elderly is often diagnosed at an advanced stage and is associated with a poor prognosis in terms of disease-free and overall survival. Surgical treatment of gastric cancer in these patients remains controversial due to the increased perioperative risk; instead, subtotal gastrectomy is preferred when feasible. Total gastrectomy with or without combined resections of adjacent organs is associated with higher rates of postoperative morbidity and mortality. For advanced cancer, palliative resection is preferable, whenever possible, to gastroenterostomy. Morbidity and mortality are higher in the elderly, probably related to the comorbidities in these patients. T stage, lymph node metastases, and depth of invasion of the primary tumor are recognized as independent prognostic factors in terms of overall survival. The impact of multimodality treatment in the elderly cannot be clearly evaluated; currently, adjuvant chemotherapy is recommended in otherwise healthy patients. In general, age alone has not been definitively confirmed as a negative prognostic factor in patients with gastric cancer and should not preclude gastric resection. After radical resection, elderly patients have the same chance of survival as middle-age patients.
Surgery in the Multimodal Management of Gastric Cancer
978-88-470-2317-8
978-88-470-2318-5
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/3414624
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