Features of elderly patients over 75 years old with gastric cancer and surgical strategy / 中华胃肠外科杂志

ABSTRACT

The new cases and mortality of gastric cancer in the population aged over 75 years account for 21% and 30% of the cases in the whole population respectively. These elderly patients with gastric cancer are characteristic of nonspecific clinical manifestations, high proportion of upper gastric carcinoma, larger tumor size, advanced TNM stage, concomitant diseases, poor body function and high risk of complications. Specialists should pay more attention to the diagnosis and treatment of these patients. Comprehensive and systemic assessment should be performed, and concomitant diseases should be treated. Accurate preoperative staging should be accessed by EUS and CT. Individualized treatment according to the principle of precise surgery and enhanced recovery after surgery (ERAS) should be performed as follows. For early gastric cancer with low risk of lymph node metastasis, endoscopic submucosal dissection (ESD) is recommended for expanded indications. For resectable advanced gastric cancer, "downsizing" surgery obtaining ≥4 cm incisal margin is recommended, which must be based on accurate preoperative stage. And gasless laproscopy is applicable for these patients. For unresectable advanced gastric cancer, conversion therapy is not the priority unless patients with high response rate. Palliative chemotherapy, immunotherapy and best supportive care should be applied in turn. ERAS techniques application in elderly patients with gastric cancer requires careful selection.