Surgical Treatment in Elderly Patients

Gastric cancer (GC) mostly affects older people and the world’s population is aging. Therefore, although there is large evidence of a declining incidence of GC, management of the disease in older patients will remain a growing challenge for clinicians and surgeons. Since older persons are increasingly seen as effective resources for social development, the growing concerns about their well-being impose increasing pressure on public healthcare systems. A cancer diagnosis in an elderly subject can no longer imply a “simple” support therapy for symptom relief. It needs to be carefully assessed according to tumor- and patient-related therapeutic possibilities. In older people the onset of a cancer suddenly alters the multifaceted and continuous passage among physiological changes and chronic multimorbidities: an understanding of the basic state of equilibrium of each elderly woman/man allows these possibilities to be verified and “measured”, regardless of her/his year of birth. Hence, comorbidities and frailty are key to a truly patient-tailored (rather than stage-adapted) approach. In bearing with this view, this chapter will specifically analyze the surgical aspects of GC treatment (as extension of lymphadenectomy, minimally invasive surgery, and palliation) and provide some tools to be used in clinical practice.