Nonagenarians to Centenarians: A Case Series of Gastric Cancer Surgery in the Very Elderly

This letter reports the surgical outcomes of gastric cancer (GC) in super-elderly patients aged 90 years or older. As populations age and Helicobacter pylori infection declines, the proportion of elderly patients with GC is increasing worldwide [1]. In Japan, individuals aged 80 years and above account for nearly half of GC-related deaths [2]. Despite this trend, evidence regarding surgical outcomes in very old patients remains limited, partly due to incomplete postoperative follow-up caused by frailty and social factors [3]. Between 2011 and 2025, 276 patients underwent GC resection at the authors' institution, of whom eight (2.9%) were aged 90 years or older (Table 1). Complete follow-up was achieved in all cases through outpatient visits or structured telephone monitoring. Patient age ranged from 90 to 97 years. Minor postoperative complications occurred in two patients, and three patients died during follow-up. One patient died of GC 19 months after undergoing palliative surgery for gastric outlet obstruction (Case #3). The other two deaths were unrelated to cancer. Notably, one patient underwent curative surgery at 93 years of age and survived 150 months without recurrence, eventually dying of senility (Case #1). Another patient, operated on at 95 years, remains alive and disease-free after 73 months (Case #4). These two patients achieved long-term relapse-free survival and effectively became centenarians. Even among patients who have not yet reached 100 years of age, functional independence sufficient for continued outpatient follow-up has been maintained, suggesting a substantial likelihood of attaining centenarian status. Although limited by a small sample size and considerable selection bias, the findings support the feasibility and potential benefit of surgical treatment in carefully selected patients aged 90 years and above. Masayuki Urabe: conceptualization, writing – original draft, data curation, methodology, investigation. Masaya Hiyoshi: supervision, data curation, writing – review and editing. Toshiyuki Watanabe: supervision, data curation, writing – review and editing. Yojiro Hashiguchi: supervision, writing – review and editing. This study was conducted in accordance with the Declaration of Helsinki and the guidelines of our Institutional Ethics Committee (approval ID 24-33). It was exempted from the requirement for written informed consent due to its retrospective nature. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.