{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T02:59:44Z","timestamp":1790564384746,"version":"4.1.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T00:00:00Z","timestamp":1641513600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T00:00:00Z","timestamp":1641513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009158","name":"Kawasaki Medical School","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009158","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Surg Onc"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with gastric cancer are aging in Japan. It is not clear which patients and which surgical procedures have survival benefits after gastrectomy. A multivariate analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The medical records of 166 patients aged \u2265 80\u2009years who underwent gastrectomy without macroscopic residual tumors were retrospectively reviewed. Univariate and multivariate analyses using Cox proportional hazard models were performed to detect prognostic factors for overall survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In univariate analyses, age (\u2265 90 vs. \u2265 80, &lt;\u200985), performance status (3 vs. 0), American Society of Anesthesiologists physical status (ASA-PS) (3, 4 vs. 1, 2), Onodera\u2019s prognostic nutritional index (&lt;\u200940 vs. \u2265 45), the physiological score of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) (\u2265 40 vs. \u2265 20, \u2264 29), surgical approach (laparoscopic vs. open), extent of gastrectomy (total, proximal vs. distal), extent of lymphadenectomy (D1 vs. \u2265 D2), pathological stage (II\u2013IV vs. I), and residual tumor (R1 vs. R0) were significantly correlated with worse overall survival. Multivariate analysis revealed that ASA-PS [3, 4 vs. 1, 2, hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.24\u20134.24], extent of gastrectomy (total vs. distal, HR 2.17, 95% CI 1.10\u20134.31) (proximal vs. distal, HR 4.05, 95% CI 1.45\u201311.3), extent of lymphadenectomy (D0 vs. \u2265 D2, HR 12.4, 95% CI 1.58\u201397.7), and pathological stage were independent risk factors for mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ASA-PS was a useful predictor for postoperative mortality. Gastrectomy including cardia is best avoided.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12957-021-02475-0","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T08:03:09Z","timestamp":1641542589000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Prognostic factors for elderly gastric cancer patients who underwent gastrectomy"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0720-4156","authenticated-orcid":false,"given":"Shunji","family":"Endo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoki","family":"Yamatsuji","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Fujiwara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaharu","family":"Higashida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisako","family":"Kubota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideo","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshimasa","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiko","family":"Yoshimatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Sugimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomio","family":"Ueno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,7]]},"reference":[{"key":"2475_CR1","unstructured":"Population estimates by age (five-year groups) and sex. Statics Bureau of Japan, Tokyo. 2021. https:\/\/www.stat.go.jp\/english\/data\/jinsui\/tsuki\/index.html Accessed 17 May 2021."},{"key":"2475_CR2","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1002\/ags3.12324","volume":"4","author":"Y Kakeji","year":"2020","unstructured":"Kakeji Y, Takahashi A, Hasegawa H, Ueno H, Eguchi S, Endo I, et al. Surgical outcomes in gastroenterological surgery in Japan: report of the National Clinical Database 2011-2018. Ann Gastroenterol Surg. 2020;4:250\u201374.","journal-title":"Ann Gastroenterol Surg"},{"key":"2475_CR3","doi-asserted-by":"publisher","first-page":"2697","DOI":"10.21873\/invivo.12090","volume":"34","author":"K Komori","year":"2020","unstructured":"Komori K, Kano K, Aoyama T, Hashimoto I, Hara K, Murakawa M, et al. The short- and long-term outcomes of gastrectomy in elderly patients with gastric cancer. In Vivo. 2020;34:2697\u2013703.","journal-title":"In Vivo"},{"key":"2475_CR4","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1080\/03007995.2018.1520083","volume":"36","author":"JU Wong","year":"2020","unstructured":"Wong JU, Tai FC, Huang CC. An examination of surgical and survival outcomes in the elderly (65-79 years of age) and the very elderly (80 years of age) who received surgery for gastric cancer. Curr Med Res Opin. 2020;36:229\u201333.","journal-title":"Curr Med Res Opin"},{"key":"2475_CR5","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.21873\/invivo.11604","volume":"33","author":"Y Otowa","year":"2019","unstructured":"Otowa Y, Okamoto S, Fujinaka R, Arai K, Murata K, Mii Y, et al. Feasibility and effectiveness of gastrectomy for elderly gastric cancer patients. In Vivo. 2019;33:1307\u201311.","journal-title":"In Vivo"},{"key":"2475_CR6","doi-asserted-by":"publisher","first-page":"2374","DOI":"10.1245\/s10434-018-6543-1","volume":"25","author":"V Mengardo","year":"2018","unstructured":"Mengardo V, Cormack OM, Weindelmayer J, Chaudry A, Bencivenga M, Giacopuzzi S, et al. Multicenter study of presentation, management, and postoperative and long-term outcomes of septegenerians and octogenerians undergoing gastrectomy for gastric cancer. Ann Surg Oncol. 2018;25:2374\u201382.","journal-title":"Ann Surg Oncol"},{"key":"2475_CR7","doi-asserted-by":"publisher","first-page":"257","DOI":"10.4251\/wjgo.v9.i6.257","volume":"9","author":"Y Fujiwara","year":"2017","unstructured":"Fujiwara Y, Fukuda S, Tsujie M, Ishikawa H, Kitani K, Inoue K, et al. Effects of age on survival and morbidity in gastric cancer patients undergoing gastrectomy. World J Gastrointest Oncol. 2017;9:257\u201362.","journal-title":"World J Gastrointest Oncol"},{"key":"2475_CR8","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1097\/00000421-198212000-00014","volume":"5","author":"MM Oken","year":"1982","unstructured":"Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol. 1982;5:649\u201355.","journal-title":"Am J Clin Oncol"},{"key":"2475_CR9","volume-title":"Physical status classification system","author":"ASA","year":"2020","unstructured":"ASA. Physical status classification system. Schaumburg: American Society of Anesthesiologists; 2020. https:\/\/www.asahq.org\/standards-and-guidelines\/asa-physical-status-classification-system Accessed 18 Nov 2021"},{"key":"2475_CR10","first-page":"1001","volume":"85","author":"T Onodera","year":"1984","unstructured":"Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients (in Japanese). Nippon Geka Gakkai Zasshi (Journal of Japan Surgical Society). 1984;85:1001\u20135.","journal-title":"Nippon Geka Gakkai Zasshi (Journal of Japan Surgical Society)"},{"key":"2475_CR11","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1002\/bjs.1800780327","volume":"78","author":"GP Copeland","year":"1991","unstructured":"Copeland GP, Jones D, Walters M. POSSUM:a scoring system for surgical audit. Br J Surg. 1991;78:355\u201360.","journal-title":"Br J Surg"},{"key":"2475_CR12","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s12893-021-01046-0","volume":"21","author":"T Matsunaga","year":"2021","unstructured":"Matsunaga T, Ishiguro R, Miyauchi W, Shishido Y, Miyatani K, Yamamoto M, et al. Appraisal of long-time outcomes after curative surgery in elderly patients with gastric cancer: a propensity score matching analysis. BMC Surg. 2021;21:33.","journal-title":"BMC Surg"},{"key":"2475_CR13","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.ijsu.2020.03.024","volume":"77","author":"SY Kim","year":"2020","unstructured":"Kim SY, Kim JH, Chin H, Jun KH. Prediction of postoperative mortality and morbidity in octogenarians with gastric cancer - comparison of P-POSSUM, O-POSSUM, and E-POSSUM: a retrospective single-center cohort study. Int J Surg. 2020;77:64\u20138.","journal-title":"Int J Surg"},{"key":"2475_CR14","doi-asserted-by":"publisher","first-page":"219","DOI":"10.4174\/astr.2016.91.5.219","volume":"91","author":"CS Gong","year":"2016","unstructured":"Gong CS, Yook JH, Oh ST, Kim BS. Comparison of survival of surgical resection and conservative treatment in patients with gastric cancer aged 80 years or older: a single-center experience. Ann Surg Treat Res. 2016;91:219\u201325.","journal-title":"Ann Surg Treat Res"},{"key":"2475_CR15","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s10120-011-0041-5","volume":"14","author":"Japanese Gastric Cancer Association","year":"2011","unstructured":"Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101\u201312.","journal-title":"Gastric Cancer"},{"key":"2475_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10120-020-01042-y","volume":"24","author":"Japanese Gastric Cancer Association","year":"2021","unstructured":"Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24:1\u201321.","journal-title":"Gastric Cancer"},{"key":"2475_CR17","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205\u201313.","journal-title":"Ann Surg"},{"key":"2475_CR18","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1016\/j.surg.2016.10.012","volume":"161","author":"S Endo","year":"2017","unstructured":"Endo S, Shimizu Y, Ikenaga M, Ohta K, Yamada T. Survival benefit of gastrectomy for gastric cancer in patients 85 years old: a retrospective propensity score-matched analysis. Surgery. 2017;161:984\u201394.","journal-title":"Surgery."},{"key":"2475_CR19","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1093\/jjco\/28.2.112","volume":"28","author":"H Katai","year":"1998","unstructured":"Katai H, Sasako M, Sano T, Maruyama K. The outcome of surgical treatment for gastric carcinoma in the elderly. Jpn J Clin Oncol. 1998;28:112\u20135.","journal-title":"Jpn J Clin Oncol"},{"key":"2475_CR20","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1111\/ases.12883","volume":"14","author":"R Kimura","year":"2021","unstructured":"Kimura R, Moriyama T, Ohuchida K, Shindo K, Nagai S, Ohtsuka T, et al. Risk factors for postoperative pneumonia after laparoscopic gastrectomy in patients aged 75\u2009years and over with gastric cancer. Asian J Endosc Surg. 2021;14:408\u201316.","journal-title":"Asian J Endosc Surg"},{"key":"2475_CR21","doi-asserted-by":"publisher","first-page":"1810","DOI":"10.1056\/NEJMoa072252","volume":"357","author":"S Sakuramoto","year":"2007","unstructured":"Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810\u201320.","journal-title":"N Engl J Med"},{"key":"2475_CR22","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1007\/s10120-018-0834-x","volume":"22","author":"T Tanahashi","year":"2019","unstructured":"Tanahashi T, Yoshida K, Yamaguchi K, Okumura N, Takeno A, Fujitani K, et al. Questionnaire survey on adjuvant chemotherapy for elderly patients after gastrectomy indicates their vulnelabilities. Gastric Cancer. 2019;22:130\u20137.","journal-title":"Gastric Cancer"},{"key":"2475_CR23","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1093\/jjco\/hyy152","volume":"48","author":"T Mizutani","year":"2018","unstructured":"Mizutani T, Yamaguchi K, Mizusawa J, Ito S, Nishida Y, Yabusaki H, et al. A phase III trial to confirm modified S-1 adjuvant chemotherapy for pathological stage II\/III vulnerable elderly gastric cancer patients who underwent gastric resection (JCOG1507, BIRDIE). Jpn J Clin Oncol. 2018;48:1101\u20134.","journal-title":"Jpn J Clin Oncol"}],"container-title":["World Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-021-02475-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12957-021-02475-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-021-02475-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T08:04:10Z","timestamp":1641542650000},"score":1,"resource":{"primary":{"URL":"https:\/\/wjso.biomedcentral.com\/articles\/10.1186\/s12957-021-02475-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,7]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["2475"],"URL":"https:\/\/doi.org\/10.1186\/s12957-021-02475-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-676689\/v1","asserted-by":"object"}]},"ISSN":["1477-7819"],"issn-type":[{"value":"1477-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,7]]},"assertion":[{"value":"27 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The protocol for this research project was approved by the institutional review board of Kawasaki Medical School (approval number 5083-01) and conformed to the 1964 Helsinki Declaration and its later amendments or with comparable ethical standards. Written informed consent for surgery was obtained from patients as required by participating institutions. We used an opt-out recruitment strategy because the study exclusively analyzed retrospective clinical data without investigation by investigators.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"No applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no conflict of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"10"}}