| [ Summary ] |
H. pylori infection, a major cause of gastric cancer development, is highly prevalent in the elderly population, while the infection rate has dropped dramatically to less than 10 % in the younger generation in Japan. As a result, the growing number of GC patients is comprised mainly of elderly individuals. Elderly patients are generally vulnerable, suffering from a wide range of physiological impairments. Advanced age is highly associated with postoperative morbidity, and more importantly, with non‒gastric cancer‒related death during the long‒term follow up period after surgery. Special attention should be paid to aging‒related comorbidities to tailor the optimal treatment in this population. Surgery is the mainstay for achieving a "cure"in this disease entity. Prophylactic para‒aortic lymph node dissection, splenectomy, as well as omentobursectomy, were no longer standard options according to the results of randomized control trial. Japanese D2 lymphadenectomy for advanced gastric cancer is still evolving toward less invasive approaches. Perioperative chemotherapy is a promising approach for further improvement of survival outcomes. Adjuvant chemotherapy for stage II/III disease is established, however, candidates and optimal regimens are still under debate in the neoadjuvant setting. |