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Is Extended Lymphadenectomy Needed for Elderly Patients With Gastric Adenocarcinoma?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Extensive surgery is associated with greater mortality for elderly patients. For gastric adenocarcinoma (GA), it is unclear whether the benefit of an extended lymphadenectomy in this population outweighs the associated risks. This study aimed to determine the impact of lymphadenectomy on postoperative outcomes and survival for the elderly.

Objective

To determine the impact of lymphadenectomy on postoperative outcomes and survival for elderly.

Methods

From a cohort of 19 centers, patients who underwent resection of GA with curative intent between 1997 and 2010 were included in this study. Lymphadenectomy was defined according to the total number of lymph nodes in the surgical specimen (limited, <15; intermediate, 15–25; extended, >25). Postoperative outcomes and survival were compared between elderly (≥75 years) and younger patients and regarding the extent of lymphadenectomy for the elderly.

Results

Of 1348 patients, 386 were elderly. The elderly presented with a higher American Society of Anesthesiologist (ASA) score (ASA 3–4: 45 vs. 16.5 %; p < 0.001) as well as greater postoperative morbidity (45 vs. 37 %; p = 0.009) and mortality (8 vs. 2.5 %; p < 0.001) despite less aggressive treatment including less neoadjuvant chemotherapy (5 vs. 20 %; p < 0.001) and adjuvant chemotherapy (7 vs. 44 %; p < 0.001), fewer total gastrectomies (41.5 vs. 60 %; p < 0.001), and less extended lymphadenectomy (38 vs. 48.5 %; p < 0.001). Among the elderly patients, limited lymphadenectomy (n = 116), intermediate lymphadenectomy (n = 125), and extended lymphadenectomy (n = 145) were comparable with respect to tumor stage, perioperative treatment, morbidity, and mortality. For the elderly patients, overall survival (OS) was 30.8 months, and disease-specific survival (DSS) was 63.9 months. The extent of the lymphadenectomy did not have an impact on OS or DSS for the elderly patients.

Conclusion

The expected benefit in terms of long-term survival did not justify an extended lymphadenectomy for elderly patients.

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Conflict of Interest

All authors have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of General and Oncological Surgery, Hospices Civils de Lyon, University Hospital Lyon Sud, Pierre Bénite, France

    Guillaume Passot MD, PhD, Delphine Vaudoyer MD & Olivier Glehen MD, PhD

  2. EMR 3738, Lyon 1 University, Lyon, France

    Guillaume Passot MD, PhD & Olivier Glehen MD, PhD

  3. Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Lille, France

    Mathieu Messager MD, PhD & Christophe Mariette MD, PhD

  4. Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Norway

    Kristoffer W. Brudvik MD, PhD

  5. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA

    Bradford J. Kim MD, MHS

Authors
  1. Guillaume Passot MD, PhD
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  2. Delphine Vaudoyer MD
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  3. Mathieu Messager MD, PhD
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  4. Kristoffer W. Brudvik MD, PhD
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  5. Bradford J. Kim MD, MHS
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  6. Christophe Mariette MD, PhD
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  7. Olivier Glehen MD, PhD
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Corresponding author

Correspondence to Guillaume Passot MD, PhD.

Additional information

For the FREGAT working Group-FRENCH. FREGAT: French Eso-Gastric Tumors Working Group. FRENCH : Fédération de recherche en chirurgie.

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Passot, G., Vaudoyer, D., Messager, M. et al. Is Extended Lymphadenectomy Needed for Elderly Patients With Gastric Adenocarcinoma?. Ann Surg Oncol 23, 2391–2397 (2016). https://doi.org/10.1245/s10434-016-5260-x

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  • DOI: https://doi.org/10.1245/s10434-016-5260-x

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