The role of lymphadenectomy in gastric cancer in elderly patients

The incidence of gastric cancer in elderly patients has significantly increased in the last few decades. Recent reports show that resective surgical procedures are the best therapeutic treatment for aged patients without important pre-existing clinical disorders. The role of lymphadenectomy in elderly patients with gastric cancer is not clear. The present study analyses literature data regarding the optimal extension of lymphadenectomy in gastric carcinoma; we reviewed the data from Japanese authors and from newer multicentric prospective European studies (German Gastric Carcinoma Study Group, Dutch Gastric Cancer Group, Medical Research Council, Italian Gastric Cancer Study Group). We also analysed the clinicopathological characteristics, the site, the symptoms, the spread and recurrence patterns of gastric carcinoma in the elderly compared with adult patients. This review shows that 75-90% of the diagnosis of gastric carcinoma in aged patients is done in advanced stage and an aggressive surgical treatment is required. A pre-existing illness and the ASA stage of the patients are directly correlated to postoperative complications. For these reasons, considering the clinicopathological features of the disease, a curative surgical operation using also an extended lymph node dissection is recommended for aged patients in good health.