Surgery and Deterioration of Mental Status in Gastric Cancer Patient 80 Years of Age and Older

Masahiko Nishiyama, Kazuhiro Yoshida, Takashi Yorishima, Takashi Tanaka, Tetsuya Toge

Department of Surgery, Research Institute for Nuclear Medicine and Biology, Hiroshima University

The outcome of surgery in 52 gastric cancer patients 80 years of age and older was investigated, especially from the viewpoint of deterioration in mental status. The occurrence of postoperative complications including deterioration in mental status was closely related to the surgical procedure. The incidence was 31% (11/35) in subtotal gastrectomy, 67% (8/12) in total gastrectomy, 100% (3/3) in resection of lower esophagus and cardia, 100% (1/1) in resection of lower esophagus and total gastrectomy, and 100% (1/1) in transhiatal esophagectomy and total gastrectomy. Delirium, which developed in 14 of 52 patients (27%), was the most common postoperative complication. The incidence and average period of occurrence were 32% (8/25) and 4.5 days in subtotal gastrectomy, 43% (3/7) and7.0 days in total gastrectomy, and 100% (3/3) and 10.0 days in resection of lower esophagus and cardia. Activity score of daily living estimated by Nishimura's scale in patients with total gastrectomy decreased from 39.9 to 33.0 (p<0.05, student t-test), although improvement of senile dementia was observed in the patients who had undergone subtotal gastrectomy. We conclude that the outcome of subtotal gastrectomy is favorable considering the postoperative complications and mental changes in patients 80 years of age and older. Nevertheless, to prevent the major morbidity associated with surgery, scrupulous care is needed for the patients who require more aggressive surgical procedure.

Key words
gastric cancer in patients 80 years of age and older, postoperative complication after gastrectomy in patients 80 years of age and older, deterioration in mental status after gastrectomy in patients 80 years of age and older

Reprint requests
Masahiko Nishiyama Department of Surgery, Research Institute for Nuclear Medicine and Biolog:y, Hiroshima University
1-2-3 Kasumi, Minami-ku, Hiroshima, 734 JAPAN

Accepted
March 11, 1992

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