Survival and complications in older adult patients with resectable gastric cancer according to number of resected lymph nodes: a cohort study

TL;DR

This study examines how the number of lymph nodes removed during surgery affects survival and complications in older adults with gastric cancer.

Contribution

The study provides new insights into the lack of survival benefit from extensive lymph node removal in older gastric cancer patients.

Findings

A higher number of retrieved lymph nodes was not associated with improved overall survival in older gastric cancer patients.

The lymph node ratio was an independent risk factor for overall survival, but lymph node count was not.

Older patients undergoing gastrectomy had a high rate of major postoperative complications.

Abstract

Gastric cancer (GC) incidence in older adults is usually higher than in the general population. Whereas surgical resection accompanied by an extended lymphadenectomy is the current standard treatment for GC, the impact of the extent of lymphadenectomy on survival in older adult patients has not been sufficiently studied and may be associated with a higher rate of complications in this group of patients.

An observational retrospective cohort study was performed in patients aged ≥ 75 years with a diagnosis of GC who underwent gastrectomy with curative intent to evaluate the influence of the number of retrieved lymph nodes (< 25 vs. ≥25) on postoperative morbidity and mortality and overall survival (OS).

A total of 122 patients were included in this study; 64 were included in the group with ≥ 25 retrieved lymph nodes and 58 in the group with < 25 retrieved nodes. Patients were predominantly male (61.5%) with a median age of 79.00 (IQR: 77.00–81.00) years. The lymph node ratio was an independent risk factor for OS (HR, 8.79; 95% CI, 2.35–32.85; p = 0.001), whereas the number of retrieved lymph nodes was not associated with differences in OS and was not identified as an independent risk factor for major postoperative complications.

We did not identify that a higher number of retrieved lymph nodes was associated with an improvement in overall survival in patients aged ≥ 75 years; however, we observed a high rate of major postoperative complications in this population. Surgical decision-making in older patients with GC should be individualized, and the risk–benefit ratio must be carefully considered.

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