Tailoring Gastrectomy for the Aging Stomach: Balancing Risks and Outcomes in Elderly Gastric Cancer Patients
Ma. Jeanesse Bernardo C
ABSTRACT
Background: The burden of gastric cancer is shifting toward the elderly, particularly in East Asia where over 60% of cases occur. Despite this, patients aged ≥80 years are often excluded from clinical trials, leaving a gap in surgical guidance for this population.
Objective: To synthesize current evidence and guideline-based recommendations on optimizing gastrectomy in elderly patients (≥80 years), focusing on treatment safety, surgical extent, and the role of minimally invasive techniques.
Methods: A narrative review was conducted using international guidelines (Japanese, Korean, Western) and high-quality studies including meta-analyses and nationwide cohorts. Outcomes assessed included survival, complication rates, and surgical morbidity in elderly patients.
Results: Elderly patients face elevated surgical risk, with increased mortality (RR = 3.23) and complications (RR = 1.36). Endoscopic resection (ER) in very elderly patients (≥85 years) demonstrated favorable 5-year cancer-specific survival (90.7%). When ER is non-curative, additional gastrectomy improved survival (HR = 0.40). Laparoscopic gastrectomy (LG) in octogenarians reduced blood loss and complications while improving survival. Robotic gastrectomy (RG) showed similar benefits, with lower intraoperative blood loss and shorter hospital stay.
Conclusion: Chronological age alone should not preclude curative surgery. In elderly patients, personalized treatment guided by physiologic fitness, frailty, and patient goals enables safe and effective gastrectomy. Minimally invasive strategies such as LG and RG are viable in appropriately selected elderly patients.
