Objective We retrospectively analyzed the validity of limited lymphadenectomy (D1 and D1+) in elderly gastric cancer patients. Summary of Background Data According to the aging trend in Japan, patients with gastric cancer are continuing to age. The extent of lymphadenectomy preferable for older patients is unclear. Methods The data of 35 and 52 patients ≥80 years old with cT2- or N(+) gastric cancer who underwent gastrectomy with D2 lymphadenectomy and limited lymphadenectomy, respectively, at two institutions between 2010 and 2019 were retrospectively reviewed. Results The patients who underwent limited lymphadenectomy were older and their Onodera’s prognostic nutritional indexes were poorer than those who underwent D2 lymphadenectomy, although the differences were not significant. After propensity score matching, 28 patients in each group were analyzed. No significant differences in postoperative complications, initial recurrence sites, or causes of death were observed between the two groups except for postoperative respiratory failure, which was more frequent after D2 lymphadenectomy. The median overall survival time after D2 and limited lymphadenectomy was 73.9 and 70.9 months, respectively, with a hazard ratio of 1.32 ( p = 0.53). Conclusions D1+ or even D1 lymphadenectomy may be acceptable for patients ≥80 years old with advanced gastric cancer.

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