An Approach to Minimally Invasive Treatment in Patients With Gastric Cancer Aged Over 80 Years

The number of patients aged ≥80 years with gastric cancer (GC) has recently been increasing. Many have severe comorbidities linked to high mortality after curative surgery. Although minimally invasive surgery is widely performed for GC, elderly patients may benefit from even less invasive, non-standard strategies. We assessed the treatment outcomes of 122 patients aged ≥80 years who underwent curative gastrectomy at our hospital between 2010-2020. In pStage I, most deaths were from comorbidities, whereas deaths in pStage II/III were both disease-specific and from comorbidities. Multivariate analysis of pStage I variables identified low prognostic nutritional index, open surgery, and American Society of Anesthesiologists physical status classification ≥3 as poor prognostic factors. For pStage II/III, no factors were significantly associated with mortality. Forty-seven out of 69 patients with T1 disease would have been classified as achieving Endoscopic Curability C-2 (eCuraC-2) if endoscopic resection rather than surgery had been performed. The 5-year overall survival rates were similar (58.8% vs. 68.6%, p=0.66) in the 20 patients judged as having eCuraC-2 status after endoscopic resection, with no other additional treatment. Minimally invasive surgery with limited lymph node dissection is preferred for elderly patients with GC with severe comorbidities, including malnutrition, and observation after noncurative endoscopic resection is viable.