Outcomes of gastrectomy in octogenarians and nonagenarians: a comparative analysis in the era of minimally invasive surgery

As the population of Japan continues to age rapidly, an increasing number of patients aged ≥ 80 years are undergoing surgery for gastric cancer. Although minimally invasive techniques have improved surgical safety, operative risks in the super-elderly population (≥ 85 years) remain a significant concern. This retrospective, single-center study analyzed 72 patients aged ≥ 80 years who underwent gastrectomy for gastric cancer at our hospital between January 2014 and August 2024. Patients were stratified into two groups: the super-elderly group (≥ 85 years, n = 26) and the younger-elderly group (80-84 years, n = 46). Clinical characteristics, perioperative outcomes, and postoperative complications were compared between the two groups. A p-value of < 0.05 was considered statistically significant. The mean age was 83.7 (range: 80-93) years. Comorbidities were common, particularly cardiovascular disease (19.4%) and diabetes mellitus (27.8%). Compared with the younger-elderly group, the super-elderly group had a longer preoperative hospital stay (5.8 vs. 4.5 days) but a shorter overall hospital stay (14.3 vs. 21.1 days). Minimally invasive surgery was less frequently performed in the super-elderly group (42.3% vs. 56.5%). Postoperative complications of Clavien-Dindo grade ≥ 2 occurred in 40.3% of all patients, with a lower incidence in the super-elderly group (34.6% vs. 43.5%). Mortality from non-cancer-related causes did not differ significantly between the groups. With appropriate preoperative optimization, gastrectomy can be performed safely in patients aged ≥ 85 years. Individualized treatment strategies that account for comorbidities are essential for achieving favorable outcomes in this expanding population.