AUTHOR=Berlet Maximilian , Weber Marie-Christin , Neumann Philipp-Alexander , Friess Helmut , Reim Daniel 

TITLE=Gastrectomy for cancer beyond life expectancy. A comprehensive analysis of oncological gastric surgery in Germany between 2008 and 2018

JOURNAL=Frontiers in Oncology

VOLUME=Volume 12 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1032443

DOI=10.3389/fonc.2022.1032443

ISSN=2234-943X

ABSTRACT=Introduction: Major gastric surgery for distal esophageal and gastric cancer has a strong impact on quality of
life, morbidity, and mortality. Especially in elderly patients reaching their life expectancy, responsible use and
extent of gastrectomy is imperative to achieve a balance between harm and benefit. In the present study, the
reimbursement database (G-DRG database) of the Statistical Office of the Federal Republic of Germany was
queried to evaluate morbidity and mortality of patients aged above or below 75 years following gastrectomy.
Material and Methods: All patients in Germany undergoing subtotal gastrectomy (ST), total gastrectomy (T), or
gastrectomy combined with esophagectomy (TE) for gastric or distal esophageal cancer (ICD-10 C15.2, C15.5,
C16.0-C16.9) between 2008 and 2018 were included. Intraoperative and postoperative complications as well as
comorbidities, in-hospital mortality and extent of surgery were assessed by evaluating ICD-10 and operation
and procedure key (OPS) codes.
Results: A total of 67389 patients underwent oncologic gastric resection in Germany between 2008 and 2018.
21794 patients received ST, 41825 T, and 3466 TE respectively. In 304 cases, combinations of these in fact
mutually exclusive procedures were encoded. The proportion of patients aged 75 years or older was 51.4%
(n=11207) for ST, 32.6% (n=13617) for T, and 28.1% (n=973) for TE. In-hospital mortality of elderly patients
was significantly increased in all three groups. (p < 0.0001) General complications such as respiratory failure (p
= 0.0054), acute renal failure (p < 0.0001) acute myocardial failure (p < 0.0001), and the need for resuscitation
(ST/T: p < 0.0001 / TE: p = 0.0218) were significantly increased after any kind of gastrectomy. Roux-en Y was
the most commonly applied reconstruction technique in both young and elderly. Regarding lymphadenectomy
(LAD), systematic D2 dissection was performed less frequently in older patients than in the younger collective
in case of ST and T as well as D3 dissection. Peritonectomy and HIPEC were uncommon in elderly alongside
ST and T compared to younger patients. (p < 0.0001)
Conclusion: The clinical outcome of major oncological gastric surgery is highly dependent on patient’s age.
Elderly show a tremendously increased likelihood of in-hospital mortality and morbidity.