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World J Gastrointest Surg. Nov 27, 2021; 13(11): 1351-1360
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1351
Is surgery the best treatment for elderly gastric cancer patients?
Yoshihiko Kawaguchi, Hidenori Akaike, Katsutoshi Shoda, Shinji Furuya, Naohiro Hosomura, Hidetake Amemiya, Hiromichi Kawaida, Hiroshi Kono, Daisuke Ichikawa
Yoshihiko Kawaguchi, Hidenori Akaike, Katsutoshi Shoda, Shinji Furuya, Naohiro Hosomura, Hidetake Amemiya, Hiromichi Kawaida, Hiroshi Kono, Daisuke Ichikawa, First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
Author contributions: Kawaguchi Y performed the majority of the writing, prepared the table; Akaike H and Shoda K edited and revised the article for important intellectual content; and all authors critically reviewed and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yoshihiko Kawaguchi, MD, PhD, Doctor, First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, chuou-shi, Yamanashi 409-3898, Japan. ykawa@yamanashi.ac.jp
Received: June 26, 2021
Peer-review started: June 26, 2021
First decision: July 18, 2021
Revised: July 27, 2021
Accepted: August 25, 2021
Article in press: August 25, 2021
Published online: November 27, 2021
Processing time: 153 Days and 8.6 Hours
Abstract

As the elderly population increases, the number of patients with gastric cancer has also been increasing. Elderly people have various preoperative problems such as malnutrition, high frequency of comorbidities, decreased performance status, and dementia. Furthermore, when surgery is performed, high postoperative complication rates and death from other diseases are also concerns. The goal of surgery in the elderly is that short-term outcomes are comparable to those in nonelderly, and long-term outcomes reach life expectancy. Perioperative problems in the elderly include: (1) Poor perioperative nutritional status; (2) Postoperative pneumonia; and (3) Psychological problems (dementia and postoperative delirium). Malnutrition in the elderly has been reported to be associated with increased postoperative complications and dementia, pointing out the importance of nutritional management. In addition, multidisciplinary team efforts, including perioperative respiratory rehabilitation, preoperative oral care, and early postoperative mobilization programs, are effective in preventing postoperative pneumonia. Furthermore, there are many reports on the usefulness of laparoscopic surgery for the elderly, and we considered that minimally invasive surgery would be the optimal treatment after assessing preoperative risk.

Keywords: Elderly; Gastric cancer; Surgery; Laparoscopy; Gastrectomy; Dementia

Core Tip: The definition of elderly varies from 75 to 85 years of age and over. Therefore, we classified individuals into ages 75, 80, and 85 years and over. In addition, long-term functional performance in the elderly should consider not only prognosis but also life expectancy. Perioperative problems were discussed separately for preoperative, intraoperative, and postoperative procedures. Regarding surgery, based on the latest findings, we discussed surgical indications compared with best supportive care, laparoscopic surgery, total gastrectomy, and the extent of lymph node dissection.