Validity of Charlson comorbidity index in laparoscopic gastrectomy with D1+ lymphadenectomy for very elderly advanced gastric cancer patients

It remains unclear whether laparoscopic gastrectomy (LG) with optimal lymphadenectomy is appropriate for very elderly patients with advanced gastric cancer (AGC). This study aimed to assess the validity of LG with D1+ lymphadenectomy performed for AGC in patients aged 80 years or more. Included in this retrospective study were 122 patients who underwent curative LG for AGC between 2013 and 2018. All patients over 80 years old underwent LG with D1+ lymphadenectomy. We divided patients by age between those who were very elderly (age ≧80 years; VE group [n=57]) and those who were non-very elderly (age ＜80 years; control group [n=65]), and we compared patient and clinicopathological characteristics, intraoperative outcomes, and short- and long-term outcomes between the two groups. We also performed multivariate analyses to identify predictors of postoperative complications and prognosis. ECOG-PS of grade 2 or higher was more prevalent in the VE group than in the control group (31.5% vs 4.6%, p=0.0206), and adjuvant chemotherapy was used in relatively few VE group patients (3.5% vs 73.8%, p＜0.001). Operation time, blood loss, and postoperative morbidity and mortality did not differ between the two groups. The OS rate of VE group patients with a Charlson comorbidity index (CCI) score of 2 or less was not significantly different from that of the control group patients. The treatment of AGC by LG with D1+ lymphadenectomy to be both safe and effective in the VE group patients with the CCI score of 2 or less.