Is it safe to perform gastrectomy in gastric cancer patients aged 80 or older?: A meta-analysis and systematic review

BACKGROUND: Few studies have focused on octogenarian patients with gastric cancer (GC) who have undergone gastrectomy. This meta-analysis of published studies was performed to assess the safety of treating octogenarian GC patients with surgery. METHODS: Databases, including PubMed, Embase, Web of Science, and Cochrane Library were searched until January 2019. The incidence of preoperative comorbidities, postoperative complications, and mortality was assessed using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Further, the hazard ratios (HRs) with 95% CIs were applied for survival outcomes. RESULTS: A total of 18,179 patients with GC in 21 studies were included. Our results demonstrated that octogenarian patients were associated with a higher burden of comorbidities (OR = 2.79; 95% CI: 2.37, 3.28; P = .00), high incidences of overall postoperative complications (OR = 1.48; 95% CI: 1.22, 1.81; P = .00), medical postoperative complications (OR = 2.58; 95% CI: 1.91, 3.49; P = .00), in-hospital mortality (OR = 3.24; 95% CI: 2.43, 4.31; P = .00) and poor overall survival (HR = 1.96; 95% CI: 1.65, 2.27; P = .00). CONCLUSIONS: Considering the high burden of comorbidities, high incidences of postoperative complications and mortality, surgery for extremely elderly patients with GC requires deliberation. Individualized treatment is recommended for such patients.