Gretschel Stephen, Estevez-Schwarz Lope, Hünerbein Michael, Schneider Ulrike, Schlag Peter M
Department of Surgery and Surgical Oncology, Charité, University Medicine Berlin, Campus Buch, Robert-Rössle-Cancer Hospital, HELIOS Klinikum, Berlin, Germany.
World J Surg. 2006 Aug;30(8):1468-74. doi: 10.1007/s00268-005-0633-5.
To investigate the value of individual risk-adapted therapy in geriatric patients, we performed a consecutive analysis of 363 patients undergoing potentially curative surgery for gastric cancer.
All patients underwent extensive preoperative workup to assess surgical risk. The following criteria were evaluated in 3 age groups (<60 years, 60-75 years, and >75 years): comorbidity, tumor characteristics, type of resection, postoperative morbidity and mortality, recurrence rate, overall survival, and disease-free survival.
There was an increased rate of comorbidity in the higher age groups (51% vs 76% vs 83%; P<0.05). Cardiovascular and pulmonary diseases were most common. There was a decrease in the rate of both total gastrectomy (74%, 54%, 46%; P<0.05) and D2 lymphadenectomy (78%, 53%, 31%; P<0.05). The 30-day mortality in the 3 age groups was 0%, 1%, and 8%, respectively (P<0.05). There was only a slight difference in tumor recurrence rate (35%, 37%, and 27%; P=0.437), with no significant difference in 5-year cancer-related survival (61%, 53%, 61%; P=0.199).
Patient selection and risk-adapted surgery in elderly patients can result in acceptable therapeutic results comparable to younger patients. Limited surgery in elderly gastric cancer patients with high comorbidity does not necessarily compromise oncological outcome.
为了研究个体化风险适应性治疗在老年患者中的价值，我们对363例接受胃癌根治性手术的患者进行了连续分析。
所有患者均接受了广泛的术前检查以评估手术风险。在3个年龄组（<60岁、60 - 75岁和>75岁）中评估了以下标准：合并症、肿瘤特征、切除类型、术后发病率和死亡率、复发率、总生存率和无病生存率。
年龄较大的组合并症发生率增加（51%对76%对83%；P<0.05）。心血管和肺部疾病最为常见。全胃切除术（74%、54%、46%；P<0.05）和D2淋巴结清扫术（78%、53%、31%；P<0.05）的发生率均下降。3个年龄组的30天死亡率分别为0%、1%和8%（P<0.05）。肿瘤复发率仅有轻微差异（35%、37%和27%；P = 0.437），5年癌症相关生存率无显著差异（61%、53%、61%；P = 0.199）。
老年患者的患者选择和风险适应性手术可产生与年轻患者相当的可接受治疗效果。合并症高的老年胃癌患者进行有限手术不一定会影响肿瘤学结局。
