Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1739-1750
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1739
Changing trends in gastric and colorectal cancer among surgical patients over 85 years old: A multicenter retrospective study, 2001–2021
Ke Chen, Ming Li, Ran Xu, Ping-Ping Zheng, Meng-Ding Chen, Liang Zhu, Wen-Bin Wang, Zheng-Guang Wang
Ke Chen, Department of Vascular Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China
Ming Li, College of Pharmacy of Anhui Medical University, Hefei 230001, Anhui Province, China
Ran Xu, Department of General Surgery, First Affiliated Hospital of Wannan Medical College, Wuhu 241000, Anhui Province, China
Ping-Ping Zheng, Department of General Practice, First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, Anhui Province, China
Meng-Ding Chen, Zheng-Guang Wang, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 231000, Anhui Province, China
Liang Zhu, Department of General Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Wen-Bin Wang, Department of General Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei 231000, Anhui Province, China
Author contributions: Chen K and Ming Li and Ran Xu contributed equally to this work; Chen K, Li M, Xu R, Zheng PP, Chen MD and Zhu L collected data; Chen K, Li M and Xu R wrote the manuscript; Zheng PP, Chen MD and Zhu L analyzed the data; Wang WB and Wang ZG designed ideas.
Institutional review board statement: The study was reviewed and approved by the Clinical Medical Research Ethics Committee of the First Affiliated Hospital of Anhui Medical University (PJ2023-07-56).
Conflict-of-interest statement: All those named as authors have made a sufficient contribution to the final manuscript for submission. All authors declare no conflict of interest, and agree on consent to be listed as coauthors.
Data sharing statement: Data will be made available on request.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zheng-Guang Wang, MD, PhD, Chief Doctor, Professor, Research Scientist, Department of General Surgery, First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230001, Anhui Province, China. wangzhengguang@ahmu.edu.cn
Received: April 23, 2023
Peer-review started: April 23, 2023
First decision: May 27, 2023
Revised: May 31, 2023
Accepted: July 6, 2023
Article in press: July 6, 2023
Published online: August 27, 2023
Processing time: 124 Days and 6.4 Hours
Abstract
BACKGROUND

Whether patients over 85 years old with gastrointestinal cancer should undergo surgery remains controversial. We aimed to describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan.

AIM

To describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan.

METHODS

A total of 218 gastric cancer (GC) patients and 563 colorectal cancer (CRC) patients who underwent surgery between 2001 and 2021 were enrolled in this retrospective analysis. Changes in clinicopathological features, surgical treatments, and survival status were analyzed longitudinally at 5-year intervals.

RESULTS

Only 14 GC patients underwent laparoscopic surgery where 219 CRC patients had this procedure. Cardia and esophagogastric junction cancer increased in GC patients, and the proportion of sigmoid colon cancer decreased in CRC patients. Pulmonary infection gradually became the most common postoperative complication, its incidence in period 4 reached 48.79%. However, the incidence of anastomotic leakage decreased from 26.79% to 9.38% (P < 0.01). Additionally, 30-d mortality significantly decreased from 32.14% to 9.01%. Increases were observed in 5-year overall survival (OS) in GC patients from period 1 to period 4 (18.18% vs 33.32%, respectively) and CRC patients (0 vs 36.32%, respectively). Disease-free survival (DFS) also increased in GC and CRC patients (7.14% vs 27.74% and 0 to 36.03%, respectively). The average survival time of GC patients following radial lymphadenectomy was higher than in patients that underwent limited lymphadenectomy (26 vs 22 mo, respectively), the same was seen in CRC patients (44 vs 33 mo, respectively). This advantage was particularly evident in patients with TNM I, but not in patients with TNM II/III period cancer.

CONCLUSION

The safety as well as effectiveness of surgery in ultra-elderly patients is increasing. Radical lymphadenectomy has advantages in patients with TNM I gastrointestinal cancer, but not TNM II/III.

Keywords: Gastric cancer; Colorectal cancer; Retrospective analysis

Core Tip: The safety as well as effectiveness of surgery in ultra-elderly patients is increasing. Radical lymphadenectomy has advantages in patients with TNM I gastrointestinal cancer, but not TNM II/III.