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Objective: This study summarizes the cases of elderly patients with gastric cancer, the analysis of the characteristics of its pathogenesis, clinical characteristics and pathological features, biological behavior characteristics of elderly gastric cancer; influencing factors and further analysis of postoperative complications in the elderly provide the basis for the surgical treatment effect. Materials and Methods: Collect the Fourth Hospital of Hebei Medical University from January 1996 to December 2006 were treated by the pathological diagnosis gastroscopy biting examination pathological (preoperative or postoperative pathological) confirmed 7342 cases of gastric cancer patients ≥ 60 years old gastric patients with a total of 4015 cases, the characteristics (including sex, age, time of onset, family history of cancer, previous history of stomach problems, smoking, drinking history) in elderly patients with gastric cancer pathogenesis, clinical manifestations, complications, preoperative laboratory examinations (including endoscopy and pathological biting examination, X-ray angiography, CT and B-), tumor pathological features (including the location, size, gross morphology, histological type, degree of differentiation, depth of invasion, lymph node metastasis, visceral metastasis, pathologic stage), surgery (including surgical nature resection, reconstruction of digestive tract, postoperative complications) and postoperative complications related clinical factors (including age, gender, smoking history, preoperative comorbidity, preoperative anemia, hypoproteinemia preoperative intraoperative blood transfusion, combined organ resection), using the SPSS 13.0 statistical software for data processing, measurement data using the mean ± standard deviation (? x ± s) description, count constituent ratio or rate described by OUTCOME MEASURES statistics descriptive analysis summarizes the characteristics of the elderly gastric cancer; univariate analysis of the relationship of the various factors and the incidence of postoperative complications application χ2 test, the multivariate analysis the application logsitic regression analysis, and to the lt; 60 year-old non-elderly patients with gastric cancer influencing factors were analyzed. Results: pathogenesis, clinical manifestations, complications and preoperative laboratory examinations 1.1 Pathogenesis: 4015 cases of elderly patients with gastric cancer, 3210 cases of male patients, 805 cases of female patients, male: female was 3.99:1. Age 60-90 years, mean (67.08 ± 5.29)-year-old, 60-64-year-old patients accounted for 36.2% of 65-69-year-old patients accounted for 32.0% ,70-74-year-old patients accounted for 21.7% of 75-79-year-old patients accounted for 8.2% patients aged over 80 accounted for 1.9%. The average time of onset of 8.2 ± 51.9 months. Previous history of stomach problems accounted for 7.2% of patients, family history of cancer, accounting for 9.1% of patients, smoking accounted for 28.8% of patients, alcohol consumption accounted for 17.0% of patients. Of 1.2 clinical manifestations and preoperative complications 1.2.1 symptoms: common symptoms as follows: eating Terrier choke 42.3%, abdominal pain 22.2%, cell swelling or discomfort 19.6% of 15.8%, loss of appetite, nausea, vomiting 13.5%, weight loss or weight reduce by 12.7%, hematemesis melena 11.0%. 1.2.2 signs: Common signs as follows: 14.7% abdominal tenderness; abdominal palpable mass 4.2%; ascites positive 2.1%; supraclavicular lymph node metastasis 1.2%; rectal examination positive 0.6%. Patients with no obvious signs of 85.0%. 1.2.3 preoperative complications: concurrent bleeding 15.3% and 6.3% of the concurrent obstruction complicated by perforation of 0.3%. 1.3 Auxiliary examination: endoscopy and biting examination pathological diagnosis rate of 98.9%. Upper gastrointestinal angiography positive signs detection rate of 87.4%; the CT examination positive signs discovery rate of 81.9%; positive signs of B-ultrasound detection rate of 60.8%. 2 pathological features of 4015 elderly patients with gastric cancer underwent surgical patients with a total of 3024 cases (75.3%). Surgical patients with pathological features are as follows: 2.1 tumorigenesis parts: the upper stomach 68.6%, 15.3% of the stomach Central, 11.6% of the lower stomach, 4.5% of the whole stomach. 2.2 tumor size: lt; 5cm patients accounted for 30.1%, ≥ 5cm patients (69.9%). 2.3 tumors generally genotyping: a total of 210 cases of early gastric cancer, a total of 2814 cases of advanced gastric cancer, macroscopic type are as follows: 210 cases of early gastric cancer. Accounting for 10.9% of type Ⅰ, Ⅱ a type accounted for on 22.8%, Ⅱ b type accounted for 24.3%, Ⅱ c type accounted for 27.1% type III accounted for 12.9%, mixed 0.2%. 2814 cases of advanced gastric cancer. Borrmann type Ⅰ accounting for 1.6%, type II 42.1% 51.0% type III, type IV accounted for 4.5%, 0.9% Ⅴ type. 2.4 tumor histological type: moderately differentiated adenocarcinoma (62.3%) accounted for 27.0%, poorly differentiated adenocarcinoma, mucinous adenocarcinoma, accounting for 4.6% (1.8%), signet ring cell carcinoma, and other types of cancer accounted for 4.3%. 2.5 degree of tumor differentiation: the degree of differentiation of tumors accounted for 62.3%, 37.7% poorly differentiated tumors. 2.6 tumor infiltration depth: the T1 patients accounted for 6.9%; the T2 patients accounted for 7.5%; the T3 patients accounted for 7.3 per cent; the T4 patients accounted for 78.2%. 2.7 lymph node metastasis: N0 patients accounted for 39.6%; the N1 patients accounted for 41.2%; patients of N2 accounted for 8.7%; the N3 patients accounted for 1.2%. The remaining 9.3% of the patients did not take the lymph nodes. 2.8 adjacent organ invasion by 7.8%. 3.6% in patients with distant metastases. 2.9 pTNM staging: Ⅰ of 11.6%, Phase Ⅱ 12.5%, of Ⅲ of 72.3% of IV 3.6%. 3 surgical treatment 1996-2006 surgical treatment of gastric cancer patients with a total of 5939 cases, tended to increase the proportion of older persons. Operative nature: radical resection accounted for 79.7%, 15.2% palliative resection, bypass surgery accounted for 1.7%, simple exploratory operation accounted for 3.4%. The resection range: proximal gastrectomy 63.1% (18.1%), distal gastrectomy, total gastrectomy (9.1%) (4.6%), combined organ resection unresected 5.1%. Digestive tract reconstruction: esophageal remnant stomach stapling 56.7%, esophageal jejunostomy accounted for 10.9%, completed Ⅰ anastomosis (6.8%), Billroth Ⅱ anastomosis accounted for 13.0%, the jejunum interposition anastomosis (12.6%). Postoperative complications occurred in patients with a total of 200 patients (6.6%). Elderly patients with gastric cancer postoperative complications related clinical factors 4.1 age, gender and smoking history: lt; 75-year-old elderly gastric cancer patients with a total of 2797 cases (92.5%) and ≥ 75 years of age, elderly patients with a total of 227 cases of gastric cancer (7.5% ). 2414 cases of male and female 610 cases, the male to female ratio of 3.96:1. Smoking patients, 944 cases (31.2%), not smoking were 2080 cases (68.8%). 4.2 preoperative comorbidity: 405 cases (13.4%) patients with hypertension, heart disease patients, 203 patients (6.7%), 120 cases of diabetic patients (4.0%), 179 cases of patients with chronic lung disease (5.9%), abdominal surgery 226 cases (7.5%), other (including trauma, dentures, eye diseases, etc.), 645 cases (21.3%). The unaccompanied onset patients with 1607 cases (53.1%). 4.3 preoperative anemia and hypoproteinemia: anemia patients, 1040 cases (34.4%) patients with no anemia 1984 cases (65.6%). 508 cases (16.8%) patients with hypoproteinemia, 2516 cases (83.2%) patients with no low albumin. 4.4 intraoperative blood transfusion: intraoperative blood transfusion in 1226 cases (40.5%), and no blood transfusion in 1798 cases (59.5%). 5 clinical factors and postoperative complication 5.1 lt; 75-year-old elderly patients with gastric cancer postoperative complication rate was 6.3% in patients ≥ 75 years of age the incidence of complications was 10.1%; male patients of postoperative disease incidence of 6.9%, female patients with postoperative complication rate was 5.6%; hypertension, heart disease, diabetes, chronic lung disease, smoking, preoperative anemia, hypoproteinemia preoperative combined organ resection intraoperative blood transfusion 9 factors analyzed, the presence of these factors in patients with postoperative complication rate of 8.1%, 9.9%, 15.0%, 20.1%, 7.6%, 9.4%, 11.8%, 14.4%, 8.3% ; these factors in patients with postoperative complication rate was 6.4%, 6.4%, 6.3%, 5.8%, 6.2%, 5.1%, 5.6%, 6.2%, 5.5%, respectively. Χ2 test, gender, hypertension, heart disease, smoking (P gt; 0.05), no statistically significant; Age, diabetes, chronic lung disease, preoperative anemia, preoperative hypoalbuminemia, combined organ resection, intraoperative blood transfusion (P lt; 0.05), statistically significant. 5.2 applications logsitic of regression analysis, age factors are excluded, diabetes, chronic lung disease, preoperative anemia before surgery hypoproteinemia, combined organ resection, intraoperative blood transfusion complications independent factors. 6 factors affecting postoperative complications (lt; 60-year-old) non-elderly patients with gastric cancer compared. 6.1 preoperative anemia in elderly patients with gastric cancer and non-elderly patients with postoperative complication rates were 9.4%, 6.3%, χ2 test, P lt; 0.05, statistically significant, indicating that preoperative anemia in patients with gastric cancer, The high incidence of postoperative complications in the elderly in the non-elderly. 6.2 preoperative hypoalbuminemia elderly patients with gastric cancer and non-elderly patients with postoperative complications incidence were 11.8%, 7.2%, χ2 test, P lt; 0.05, statistically significant, indicating that low preoperative protein patients with gastric cancer, the high incidence of postoperative complications in the elderly to non-elderly. The 6.3 combined organ resection elderly patients with gastric cancer and non-elderly patients with postoperative complication rates were 14.4%, 6.3%, χ2 test, P lt; 0.05, statistically significant, combined organ resection of gastric cancer patients, the high incidence of postoperative complications in the elderly to non-elderly. 6.4 intraoperative blood transfusion in the elderly patients with gastric cancer and non-elderly patients with postoperative complication rates were 8.3%, 5.3%, χ2 test, P lt; 0.05, statistically significant, indicating that blood transfusion in surgery patients with gastric cancer high incidence of postoperative complications in the elderly to non-elderly. Conclusion: a group of elderly patients (54.7%) in the patients with gastric cancer, the male to female ratio of 3.99:1, more common in male patients. 60-74 years old accounted for 89.9% of the total number of cases in the elderly gastric cancer patients, and more common in the elderly gastric cancer to 75 years of age. Two groups of elderly patients with clinical symptoms of the most common eating Terrier choking (42.3%), and other symptoms of abdominal pain, fullness or discomfort, loss of appetite, nausea, vomiting, weight loss, or weight loss, hematemesis melena are no obvious specificity; no obvious signs on the signs up to 85% of patients; highest proportion of preoperative concurrent bleeding. Three groups of elderly patients with endoscopy and biting examination of pathological diagnosis was 98.9%. Upper gastrointestinal imaging, CT scan, B-ultrasound detection rate of positive signs were 87.4%, 81.9% and 60.8%, respectively. Can assist in the diagnosis of upper gastrointestinal imaging, application of CT and B ultrasound, provide the basis for the elderly gastric preoperative staging of discrimination. Four group of elderly patients with tumor site in the upper stomach 68.6% (69.9%); tumor ≥ 5cm; typing of early gastric cancer, type II common, accounting for 74.2%; advanced gastric cancer in Borrmann type II The type and proportion of type III sum of up to 93.1%; well-differentiated tumor (moderately differentiated adenocarcinoma) accounted for 62.3%. The elderly gastric predilection in the upper stomach, ulcerated more common, a high degree of differentiation, but due to the longer duration, tumor ≥ 5 cm in patients with more common. 5 group of elderly patients with tumor infiltration depth of T4, 78.2% of patients; lymph node metastasis of N0 patients accounted for 39.6% of N1 patients accounted for 41.2%; TNM staging Ⅲ Ⅳ period the proportion of patients reached 75.9%. Elderly patients with gastric cancer due to late discovery, longer duration, the tumor is often deeply invasive depth later installments, but due to the histological lower grade, lymph node metastasis less. Six groups in all the surgical treatment of patients with gastric cancer, the proportion of elderly people is rising. Tumor resection rate of up to 94.9%, especially radical resection rate of 79.7%, indicating that in the case of strengthening the perioperative management, elderly patients with gastric cancer take surgery is relatively safe and feasible. 7 group resection larger total gastrectomy and combined organ resection patients accounted for 13.7%, of which only 4.6% of combined organ resection. And, depending on the specific circumstances resection surgery, using a variety of digestive tract reconstruction. Description taken to meet the conditions based on the relative decrease of resection, and select the appropriate agreement. 8 age factor is not independent prognostic factors complications. Diabetes, chronic lung disease, preoperative anemia before surgery hypoproteinemia combined organ resection, intraoperative blood transfusion factors such as independent prognostic factors of postoperative complications.
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