Background and Objectives The long-term prognosis of elderly gastric cancer patients is poor because of the cancer and unrelated comorbidities. We investigated the risk factors for mortality after gastrectomy to aid surgeons in deciding the correct operative procedure for elderly gastric cancer patients. Methods A total of 414 gastric cancer patients surgically treated between 2002 and 2012 were divided into two groups A (≥75 years) and B (<75 years). Data were collected retrospectively and analyzed using the Estimation of Physiological Ability and Surgical Stress (E-PASS) scoring system as a predictor of postoperative complications. Results Overall survival (P < 0.001), disease-specific survival (P = 0.029), and survival rate related to comorbid disease (P < 0.001) were significantly reduced in elderly patients compared with younger patients. Surgical treatment for Group A involved lesser extent of nodal resection (P < 0.001). Multivariate analysis revealed that a comprehensive risk score (CRS) ≥0.5 based on the E-PASS score (P = 0.022) and severe postoperative complication (P = 0.002) were independent risk factors for mortality from comorbid disease. Conclusions Thus, E-PASS-based CRS was a good predictor of comorbidity-related mortality. CRS may help surgeons select elderly patients with gastric cancer for surgical or other therapies.
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