{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:00:14Z","timestamp":1790704814389,"version":"4.1.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Japan\u2019s rapidly aging population has led to an increase in elderly patients undergoing gastrectomy for gastric cancer. However, the impact of postoperative complications on survival in patients aged \u226580 years remains unclear. This study aimed to evaluate the association between postoperative complications and survival outcomes in patients aged \u226580 years with gastric cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 61 patients aged \u226580 years who underwent gastrectomy with D2 lymph node dissection between 1999 and 2020. Postoperative complications were classified according to the Clavien-Dindo (CD) classification into a \u201cno or minor complication group\u201d (CD Grade\u2009\u2264\u2009II, including no postoperative complications) and a \u201cmajor complication group\u201d (CD Grade\u2009\u2265\u2009III), and the impact of postoperative complications on survival outcomes were assessed. A subgroup analysis excluding macroscopic type 4 was also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Postoperative complications occurred in 24 patients (39.3%), of which 8 (13.1%) experienced major complications. Patients in the major complication group had a significantly longer postoperative hospital stay, while other baseline characteristics were similar between groups. Kaplan\u2013Meier analysis showed a trend toward poorer OS in the major complication group (P\u2009=\u20090.063), and recurrence-free survival (RFS) was significantly worse in this group (P\u2009=\u20090.004). Multivariate analysis showed that postoperative complications of CD grade\u2009\u2265\u2009III were independently associated with poorer OS (HR 2.51; 95% CI 1.01\u20136.24; P\u2009=\u20090.049). Subgroup analysis in patients without type 4 also showed significantly worse OS in the major complication group (P\u2009=\u20090.036).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study showed that postoperative complications were associated with poorer OS and RFS even in patients aged \u226580 years with gastric cancer. Future large-scale studies are needed to further clarify this association and optimize treatment strategies for this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359100","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:29:37Z","timestamp":1790702977000},"page":"e0359100","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic impact of postoperative complications among elderly patients with gastric cancer"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9948-6869","authenticated-orcid":true,"given":"Kohei","family":"Matsuoka","sequence":"first","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0116-0922","authenticated-orcid":true,"given":"Yuichiro","family":"Miki","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3880-762X","authenticated-orcid":true,"given":"Ryota","family":"Kawai","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate school of Medicine","place":["Osaka, Japan"],"department":["Department of Medical Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Nishiyama","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2164-7394","authenticated-orcid":true,"given":"Yuki","family":"Seki","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Kasashima","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mami","family":"Yoshii","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuro","family":"Tamura","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatsune","family":"Shibutani","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Toyokawa","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumi","family":"Shintani","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate school of Medicine","place":["Osaka, Japan"],"department":["Department of Medical Statistics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoshi","family":"Maeda","sequence":"additional","affiliation":[{"name":"Osaka Metropolitan University Graduate School of Medicine","place":["Osaka, Japan"],"department":["Department of Gastroenterological Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"pone.0359100.ref001","unstructured":"National Cancer Center Japan. 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