[Results of Surgical Treatment for Gastric Cancer in the Elderly Over 85 Years Old].

Although the number of gastric cancers in elderly is increasing with the aging population, the indications of surgical treatment depend on the individual cases and the decisions of doctors. We investigated the outcomes of gastrectomy in elderly patients aged 85 years and older who underwent surgery at our hospital. From 2014 to 2022, 72 cases of gastrectomy were performed in the elderly. The approaches were laparotomy in 28 cases, laparoscopic in 42, and robot-assisted in 2. There were 57 cases of distal gastrectomy, 7 cases of proximal gastrectomy, and 8 cases of total gastrectomy. The median operation time was 200 minutes, and the postoperative hospital stay was 14 days. There were 14 cases of complications of Grade Ⅱ or higher according to the Clavien-Dindo classification. Although intra-abdominal complications were not many, respiratory and circulatory complications were occasionally observed. The median follow-up period was 14.6 months, there were 10 deaths from other diseases. Risk factors for death from other diseases were laparotomy, postoperative complications, and outcomes other than discharging home. Although gastrectomy may be performed safely even in the elderly, it is important to pay attention to the patients' conditions particular to the elderly and to plan the surgery accordingly.

[A Case of Primary Somatostatin-Producing Tumor of the Duodenum with Liver Metastases with Long-Term Survival of More than 20 Years].

A 52-year-old woman underwent esophagogastroduodenoscopy after an abnormal medical examination, which revealed a mass lesion over half the circumference of the superior duodenal angulus. Immunostaining was diffusely positive for somatostatin, synaptophysin, and chromogranin A. A 3 cm-sized mass in the pancreaticoduodenal region and multiple nodular lesions of a few mm in both lobes of the liver were revealed by CT. The diagnosis is primary somatostatin-producing tumor of the duodenum with multiple liver metastases. She underwent gastric jejunal bypass for impaired transit. Afterwards hepatic infusion and systemic chemotherapy were continued, and 5 years passed without progression. When she stopped chemotherapy for 6 months, she started somatostatin analogue therapy because of the increase of the tumors. The tumors did not increase, and 20 years have passed since the start of treatment. We report a case of primary somatostatin-producing tumor of the duodenum with liver metastases that is still alive for a long period of time, with a review of the literature.