In industrialized countries, life expectancy has increased consistently over the past decades. Life expectancy (male/female) in Japan was 18.86/23.89 years for those 65 years old, 11.58/15.38 years for those 75 years old, and 6.18/8.30 years for BAY 57-1293 in vitro those 85 years old by the complete life table in 2010, respectively. In Japan the population peaked in 2004 and has been decreasing recently. However, the number of people 65 years old and over is increasing continuously, being 23.0 % in 2010; further, 20 % of gastric cancer patients in Japan are more than 80 years old. According to the aging

society, the current status of treatment strategy for elderly patients with gastric cancer is discussed. There is controversy regarding strategies for treating elderly patients with gastric cancer. The number of deaths of elderly patients with gastric cancer is increasing, but objective indicators for appropriate criteria of surgery and standard criteria of perioperative complications are not yet established. In the treatment algorithm of the NCCN guideline, there are items of “medically fit” and “medically unfit,” but no definite criteria. BMS-777607 There are several prediction scoring systems for postoperative complications such as E-PASS, POSSUM Score, and so on. However, the published research

is very limited because of the strict selection and underrepresentation of elderly patients in clinical trials. Elderly patients had significantly more co-morbidities and a poorer nutritional status than younger patients. The presence of co-morbidities was the independent factor affecting morbidity

and mortality. In elderly patients, surgical strategies must be modulated on the basis of co-morbidities, tumor stage, and future quality of life. It is important to control intraoperative bleeding and to avoid extensive ZD1839 molecular weight lymph node dissection and combined resection of other organs. Extended lymph node dissection in elderly patients did not influence the 5-year survival rate, and the mortality and morbidity rates in extended lymph node dissection were higher than in limited dissection. Therefore, the surgical intervention had best be minimized. The decision whether to perform surgery for elderly patients should be made according to the individual physical and clinical condition such as favorable respiratory function, cardiac function, performance status, and general condition. Preoperative rehabilitation or training might be somewhat effective. The remote survival rate after curative gastrectomy of the elderly patients was lower than that of the younger patients because there were more non-cancer deaths. However, they also had a good prognosis whether or not other causes of death were considered.