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BMC Geriatrics

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Volume 10 Supplement 1

de Senectute: Age and Health Forum

Open Access

Patterns of neoplastic recurrence in gastrectomized elderly patients

  • F Guida,
  • A Antonino1,
  • E Coppola Bottazzi1,
  • G Formisano1,
  • U Avallone,
  • G Aprea1 and
  • G Persico1
BMC Geriatrics201010(Suppl 1):A10

https://doi.org/10.1186/1471-2318-10-S1-A10

Published: 19 May 2010

Background

The incidence of gastric cancer in elderly patients is increasing and the choice of treatment is controversial among physicians, oncologists and surgeons. In addition, about 2/3 of patients present a neoplastic recurrence after a curative intervention [1]. The aim of this study is the analysis of the factors which influence the risk of recurrence in elderly patients.

Materials and methods

All patients who received a gastrectomy for adenocarcinoma in our surgical department from January 1998 to December 2002 were admitted to the study. Inclusion criteria were: a) Curative resection (R0); b)no metastases before surgery; c)no other primitive neoplasms; d)consensus of the patient for a follow-up of 5 years. Recurrence was indicated as haematogenous, peritoneal or locoregional on the basis of the first site of metastases. Patients were divided into two groups by age: cut-off was considered 70 years old.

Results

48 patients were admitted to the study : 26 male and 22 female patients, with a average age of 61,9 years old (37 – 80). 16 patients were ≥ 70 years old.

During a 5-year follow-up we observed in the older group 9 recurrences (56%) : in 44% cases there was a peritoneal recurrence, in 33% a haematogenous recurrence and in 23% of patients a locoregional disease. In patients < 70 years old we observed a peritoneal recurrence only in 5 % of cases. (Table 1).
Table 1

Recurrence site for age

RECURRENCE SITE

≥ 70 YEARS (%) – 9 patients

< 70 YEARS (%) – 18 patients

Peritoneal

4 (44%)

1 (5%)

Haematogenous

3 (33%)

6 (33%)

Local

2 (23%)

11 (62%)

Factors correlated with a neoplastic recurrence in the older group were: pTNM III at diagnosis (78% vs 43%), subtotal gastrectomy (65% vs 56%), Lauren diffuse adenocarcinoma (45% vs 33%) and a Linfonodal ratio (LNR) ≥ 20 % (89% vs 30%).(Table 2)
Table 2

Factors associated with recurrence in patients ≥ 70 years

 

Neoplastic recurrence + (%)

Neoplastic recurrence – (%)

Patients

9 (56%)

7 (44%)

Male Female

6 (65%)3 (35%)

5 (70%)2 (30%)

pTNM I

pTNM II

pTNM III

1 (11%)1 (11%)7 (78%)

1 (14%)3 (43%)3 (43%)

Total gastrectomy

Subtotal gastrectomy

3 (35%)6 (65%)

3 (44%)4 (56%)

Intestinal

Diffuse

5 (55%)4 (45%)

4 (67%)3 (33%)

LNR < 20%

LNR ≥ 20%

1 (11%)8 (89%)

5 (70%)2 (30%)

Conclusions

In elderly patients we observed a neoplastic recurrence in 56% of cases: first site of disease was peritoneum (44% ) then haematogenous recurrence (33%).In younger patients, instead, a locoregional recurrence was more frequent (62% vs 23%). Predictive factors of neoplastic recurrence in elderly patients were: pTNM III, subtotal gastrectomy, Lauren diffuse adenocarcinoma and a LNR ≥ 20 %. These factors can help the surgeon and the oncologist to identify, in a population of elderly gastrectomized patients, who needs a closer follow-up due to a higher risk of recurrence, in order to permit a more aggressive therapy.

Authors’ Affiliations

(1)
Department of General and Geriatric Surgery and Diagnostic and Operative Endoscopy, University of Naples “Federico II”

References

  1. Whiting J, Sano T, Saka M, Fukagawa T, Katai H, Sasako M: Follow-up of gastric cancer: a review. Gastric Cancer. 2006, 9: 74-81. 10.1007/s10120-006-0360-0.PubMedView ArticleGoogle Scholar

Copyright

© Guida et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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