Background: The risk of surgery for gastric cancer has not been fully evaluated, and this study aimed to assess the severity of postoperative complications after D2 or modified D2 gastrectomy in elderly patients.
Methods: Eligible patients were retrospectively selected from the Kanagawa Cancer Center database between 1990 and 2009 based on the following criteria: age ≥80 years and D2 or modified D2 gastrectomy as a primary treatment for gastric cancer. The severity of complications was evaluated using the Clavien-Dindo classification.
Results: A total of 83 patients with a median age of 82 years (range 80-88 years) were entered in this study. Sixty (72 %) had at least one co-morbid condition. American Society of Anesthesiologists scores were 2 in 66 patients and 3 in 17 patients. The extent of gastrectomy was distal in 65 (78 %) and total in 18 (22 %) patients. The procedure used for lymphadenectomy was modified D2 in 38 (46 %) and D2 in 45 (54 %) patients. Altogether, 18 complications were observed in 15 patients. The overall morbidity rate was 18 % [95 % confidence interval (CI) 9.7-26.2 %], and the mortality rate was 3.6 % (95 % CI 0-7.6 %). Complications were classified as grade 2 (n = 9), grade 3a (n = 1), grade 3b (n = 4), grade 4 (n = 1), and grade 5 (n = 3). Severe complications (≥ grade 3) occurred in 8.4 % (95 % CI 2.4-14.4 %).
Conclusions: The morbidity rate was acceptable, but that of severe complications was high, suggesting that surgery for gastric cancer in elderly patients is risky and should be limited.