Surgical Management of Gastric Cancer in Elderly Patients: Results of a Multicenter Cohort of the French Surgical Association.

Introduction: Gastric cancer primarily affects the elderly, but surgical management varies with age. This multicenter, retrospective cohort study assessed treatment approaches and outcomes in gastric cancer patients based on age.

Methods: Between 2007 and 2017, 2,131 patients treated in French Surgical Association centers were identified. Patients with metastatic disease, those who did not undergo gastrectomy, those who underwent emergency surgery, those who underwent hyperthermic intraperitoneal chemotherapy and those with unspecified birth dates were excluded. The final cohort of 1,426 patients was divided into three age groups: <70 years (group 1, 60%), 70-79 years (group 2, 27%), and ≥80 years (group 3, 13%).

Results: Elderly patients were more often female and received less neoadjuvant chemotherapy (58% vs. 43% vs. 17%, p<0.001). Despite similar tumor locations, they underwent fewer total gastrectomies (68% vs. 55% vs. 43%, p<0.001) and D2 dissections (22% vs. 22% vs. 12%, p=0.007). Medical complications increased with age, while surgical complications were not significantly higher in group 3. Advanced age was not an independent risk factor for severe postoperative complications (Dindo ≥III). Pathologic results were comparable, but elderly patients received less postoperative treatment (67% vs. 45% vs. 16%, p<0.001). Five-year overall survival decreased with age (64% vs. 52% vs. 37%, p<0.001), while cancer-specific survival remained stable (69% vs. 67% vs. 63%, p=0.56).

Conclusion: Advanced age does not independently increase the risk of postoperative morbidity and should not justify less aggressive surgery. Despite receiving less perioperative treatment, selected elderly patients maintain a comparable cancer prognosis to younger individuals.