Current Status of Gastrectomy for Gastric Cancer in Oldest-old Patients Aged 85 Years or Older

Purpose This study aimed to investigate the safety of gastrectomy for gastric cancer in oldest-old patients aged >= 85 years. Methods This study retrospectively analyzed the patients aged >= 85 years who diagnosed with gastric cancer between 2008 and 2022. The study patients were divided into three groups: a surgery group, an endoscopic submucosal dissection (ESD) group, and a non-surgery and non-ESD group (n = 64, 57, and 152). Surgical outcomes and 3-year overall and recurrence-free survival (OS and RFS) were investigated. Results In the surgery group, the study cohort comprised 30 males and 34 females with a median age of 87 years. Distal, proximal, and total gastrectomy (DG, PG, and TG) were performed in 54, 1, and 9 patients, respectively. There were 27, 16, 17, and 4 patients with pStage I, II, III, and IV, respectively. Thirty-day morbidity with Clavien-Dindo grade >= 3 and 30-day mortality were 12.5% and 3.1%, respectively. Kaplan-Meier curves for the 3-year OS and RFS demonstrated that survival curves worsened with increasing pStage (p = 0.005 and p < 0.001, respectively). In multivariate analyses for the 3-year OS and RFS, TG and pStage >= III were independent risk factors (p = 0.028 and 0.011 in OS, p = 0.021 and 0.001 in RFS). In comparisons of 3-year OSs among the three groups in each cStage, survivals in the surgery group were consistently better than those in the non-surgery and non-ESD group in cStages I to III (p < 0.001, 0.001, and < 0.001 in cStage I, II, and III, respectively). Conclusion Our findings suggest that the radical gastrectomy for gastric cancer can be performed safely and has a chance to improve survival even in the oldest-old patients aged >= 85 years.