Etoh Tsuyoshi, Katai Hitoshi, Fukagawa Takeo, Sano Takeshi, Oda Ichiro, Gotoda Takuji, Yoshimura Kimio, Sasako Mitsuru
Gastric Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
Gastrointest Endosc. 2005 Dec;62(6):868-71. doi: 10.1016/j.gie.2005.09.012.
The Japanese population is rapidly aging, and the actual number of elderly patients with gastric cancer, including early cancer, has been increasing, even though the standardized incidence of gastric cancer in the population is decreasing. The optimal treatment for these patients remains a challenge to the surgeon. The aim of this retrospective analysis was to describe the results of gastrectomy and EMR for early gastric cancer in elderly patients (80 years of age and over).
This is a retrospective review of 93 elderly patients who had undergone gastrectomy or EMR at the National Cancer Center Hospital for early gastric cancer. EMR was performed aiming en bloc local resection with a clear curative margin (R0). The clinicopathologic characteristics, comorbidity, postoperative mortality, and outcome were recorded.
Gastrectomy was performed in 44 patients (surgery group) and EMR in 49 patients (EMR group). There were significant differences in mean tumor size (p < 0.05), histologic type (p < 0.05), and depth of tumor invasion (p < 0.05) between the two groups. There was no significant difference in comorbidity between the two groups. No operative death was reported in either group. In the EMR group, 7 patients were reported to have recurrence of local disease and two patients died of advanced disease. There were no significant differences in the overall 3-year survival rate or the 5-year survival rate between the surgery group and EMR group (73.5% vs. 82.5% and 55.0% vs. 62.5%, respectively).
EMR (R0) resection was performed safely in the elderly, and the overall results were excellent, the same as the results with gastrectomy. Gastrectomy can still be performed if EMR is unsuccessful.
日本人口正在迅速老龄化，尽管胃癌的标准化发病率在下降，但包括早期癌症在内的老年胃癌患者的实际数量一直在增加。对于这些患者的最佳治疗方法仍然是外科医生面临的挑战。这项回顾性分析的目的是描述老年患者（80岁及以上）早期胃癌的胃切除术和内镜黏膜切除术（EMR）的结果。
这是一项对93例在国立癌症中心医院接受早期胃癌胃切除术或EMR的老年患者的回顾性研究。EMR的实施旨在进行整块局部切除并获得清晰的切缘（R0）。记录临床病理特征、合并症、术后死亡率和结果。
44例患者接受了胃切除术（手术组），49例患者接受了EMR（EMR组）。两组之间的平均肿瘤大小（p<0.05）、组织学类型（p<0.05）和肿瘤浸润深度（p<0.05）存在显著差异。两组之间的合并症无显著差异。两组均未报告手术死亡。在EMR组中，7例患者报告有局部疾病复发，2例患者死于晚期疾病。手术组和EMR组的3年总生存率或5年生存率无显著差异（分别为73.5%对82.5%和55.0%对62.5%）。
老年患者安全地进行了EMR（R0）切除，总体结果良好，与胃切除术的结果相同。如果EMR不成功，仍可进行胃切除术。
