Abstract
Objective: To compare the outcome after limited and extended gastric resections to find out whether extended lymph node dissection is indicated for gastric cancer in elderly patients.
Design: Retrospective study.
Setting: University hospital, Japan.
Subjects: 182 patients over 75 years of age with gastric cancer who had gastric resections from 1980 to 1995.
Interventions: 161 patients had limited lymph node dissection (limited group) and 21 had extended lymph node dissection (extended group).
Main outcome measures: Histopathological features, morbidity, mortality, and long-term survival.
Results: Postoperative morbidity was 27% (n = 44) in the limited group and 57% (n = 12) in the extended group, and postoperative mortality was 1% (n = 2) in the limited group and 10% (n = 2) in the extended group; these differences are significant (p = 0.005 and p = 0.002). The 5-year survival did not differ significantly between the two groups. Only the T classification and presence of lymph node metastases had a significant influence on the outcome of gastric cancer in elderly patients.
Conclusions: The presence of lymph node metastases is a critical factor in the prognosis of gastric cancer, and extended lymph node dissection has therefore been recommended. However, extended lymph node dissection in elderly patients did not influence the 5-year survival; in addition, the mortality and morbidity in the extended group were higher than in the limited group. Extended lymph node dissection is therefore usually not indicated for gastric cancer in elderly patients.