Course and predictors of postoperative outcomes in older patients with localized gastric adenocarcinoma treated preoperatively

132 Background: Older patients with localized gastric adenocarcinoma (LGAC) suffer from substantial postoperative morbidity and mortality; however, postoperative outcomes in older patients who have received preoperative chemotherapy and/or chemoradiation have not been reported. Our study examined the impact of age and other covariates on baseline, surgical and postoperative characteristics and explored potential predictors of postoperative outcomes. Methods: Patients with LGAC who were treated with chemotherapy (n = 36; 18%) and/or chemoradiation (n = 167; 82%) followed by surgery (n = 203) were grouped in 2 categories by age: 1) ≥ 65 years old (n = 70) and 2) < 65 years old (n = 133). The short-term outcomes included postoperative morbidity and mortality, and the long-term outcomes overall survival (OS) and progression-free survival (PFS). Potential predictors of 90-day postoperative outcomes were identified i) by age group and ii) by a number of other covariates. Descriptive statistics and survival analyses were utilized. Results: The 90-daypostoperative morbidity rate was similar in older and younger patients(61 vs 58%; p = 0.6549). The 90-day mortality rate did not differ statistically between the two groups (3 vs 0%; p = 0.1178). Although major Clavien grade III/IV complications after surgery were more common in older patients, this difference did not reach statistical significance (17 vs 12%; p = 0.3919). The long-term outcomes in terms of OS and PFS were also similar (p = 0.8629 and p = 0.558 respectively). The effect of patient age and ECOG PS on outcomes was not significant. Instead, other factors, such as Charlson comorbidity index (p = 0.0114), length of hospital stay (p = 0.0009), median operative time (p = 0.006) and presence of diabetes (p = 0.0282) were strong predictors of postoperative complications. Conclusions: Our data demonstrate that older patients with LGAC who received preoperative therapy had similar outcomes with younger patients but were more likely to demonstrate higher morbidity, although the differences were not statistically significant. Comorbidity indices provided more information than age in identifying postoperative short and long-term outcomes.