Selection of Surgical Procedure in the Elderly with Advanced Gastric Cancer / 대한암학회지

ABSTRACT

PURPOSE: The quality of life has become increasingly important as an outcome when assessing patients who have had surgery for advanced gastric cancer in the elderly. The purpose of this study was to study the validity of quality of postoperative life as a criterion in the decision-making process as well as the results of operation for advanced gastric cancer in the elderly. MATERIALS AND METHODS: Spitzer's quality of life index, postoperative mortality and survival were evaluated in 67 patients(over 65 years of age) with advanced gastric cancer who had undergone operation between 1988 and 1997 at the Department of Surgery, Kangnam Sacred Heart Hospital. RESULTS: The quality of life score and median survival correlated with TNM clinical stage(IIIa; 7.1+/-1.8, 36.0 months vs. IIIb 5.8+/-2.8, 28.6 months vs. IV 2.9+/-1.9, 4.5 months), resectability(reseetion 5.9+/-2.7, 21.0 months vs. no resection 3.0+/-2.0, 4.0 months), curability(curative operation 6.5+/-2.4, 29.0 months vs. palliative operation 3.3+/-2.4, 6.0 months), type of gastrectomy(subtotal gastrectomy 6.4+/-2.7, 28.0 months vs. totai gastrectomy 4.5+/-2.6, 9.0 months), but not with age or sex. There was a difference in operative mortality according to age group(65~70 years 7.8% vs. >70 years 18.8%), resectability(resection 7.4% vs. no resection 23.0%) and curability (curative operation 2.3% vs. palliative operation 25.0%). CONCLUSION: The results suggest that surgical resection offers the only chance for improved survival and qulaity of life. Gastric resection, even with total gastrectomy, can be undertaken to reduce tumor burden, decrease threats of obstruction, hemarrhage, or perforation and improve quality of life in the elderly if there is little coexisting impairment.