Does Age have an impact on Surgical and Oncologic Outcomes After Curative Resection for Gastric Cancer: A Ten-Year Single-Center Retrospective Study

Abstract

Background: Gastric cancer remains a major health burden in Slovenia, particularly among elderly patients. With increasing life expectancy, a growing number of patients aged ≥70 years are expected to undergo curative surgery. This study compared clinical, surgical, and oncologic outcomes between elderly (≥70 years) and younger (<70 years) patients with gastric cancer.

Methods: A single-center retrospective cohort study included patients who underwent curative-intent surgery for gastric adenocarcinoma between 2015 and 2024. Patients were stratified by age. Demographic data, comorbidities, tumor characteristics, surgical variables, postoperative complications (Clavien–Dindo classification), and overall survival (OS) were analyzed. Survival was assessed using the Kaplan–Meier method, and prognostic factors were evaluated using Cox proportional hazards regression.

Results: A total of 433 patients were included (229 <70 years; 204 ≥70 years). Elderly patients had higher ASA scores and a higher incidence of major postoperative complications. R0 resection rates and surgical radicality were comparable between groups; however, elderly patients more frequently underwent subtotal gastrectomy and less extensive lymphadenectomy. Perioperative chemotherapy was more commonly administered in younger patients. Tumor characteristics and TNM stage distribution were similar between groups. Five-year OS was significantly lower in elderly patients (37.3% vs. 59.6%, p < 0.001).

Conclusions: Curative gastric cancer surgery should not be denied based solely on chronological age. Carefully selected elderly patients can achieve acceptable surgical and oncologic outcomes, highlighting the importance of biological age and functional status in treatment decision-making