Whether chronological age is an independent prognostic factor in elderly gastric cancer patients remains controversial. This study aimed to evaluate the impact of age on postoperative complications and long-term survival in patients ≥ 75 years old.

We retrospectively analyzed 247 patients ≥ 75 years old who underwent R0 resection for gastric cancer. Patients were stratified using age cutoffs of 80 and 85 years, and propensity score matching was performed. Clinicopathological characteristics, postoperative complications, and survival outcomes were evaluated.

After propensity score matching, no significant differences in postoperative complication rates were observed between age groups. Before matching, the ≥ 80-year-old and ≥ 85-year-old groups demonstrated significantly worse overall survival (OS) and recurrence-free survival (RFS). However, these differences were no longer significant after matching. Multivariate analysis identified performance status, Charlson Comorbidity Index, neutrophil-to-lymphocyte ratio, Prognostic Nutritional Index, type of gastrectomy, and pathological stage as independent prognostic factors for OS. Age was not a significant factor at either cutoff.

Chronological age is not an independent prognostic factor following R0 resection for gastric cancer in patients ≥ 75 years old. Surgical decisions should be based on a comprehensive assessment of functional status, comorbidities, nutritional and inflammatory conditions, rather than age alone.