Morita Masaru, Egashira Akinori, Yoshida Rintaro, Ikeda Keisuke, Ohgaki Kippei, Shibahara Kotaro, Oki Eiji, Sadanaga Noriaki, Kakeji Yoshihiro, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
J Gastroenterol. 2008;43(5):345-51. doi: 10.1007/s00535-008-2171-z. Epub 2008 Jul 1.
The purpose of this study was to clarify the indications for an esophagectomy in elderly patients (especially patients over 80 years of age) with esophageal cancer.
A total of 668 patients with thoracic esophageal cancer who underwent an esophagectomy by the transthoracic approach were divided into three groups according to age, namely, groups I (>80 years, n=16), II (70-79 years, n=158), and III (<or=69 years, n=494). In group I, surgery was only done in patients with PS 0 or 1, as well as normal cardiac and pulmonary functions.
The incidence of preoperative pulmonary risk was 16% and 7% in groups II and III, respectively (P<0.01). The morbidity rates of group II and III were 42% and 32%, respectively (P<0.05). Pulmonary complications occurred in 18% and 10%, respectively, and cardiovascular complications occurred in 11% and 4%, respectively (P<0.01). In group I, the morbidity and 30-day mortality rates were 25% and 0%, respectively, and pulmonary and cardiovascular complications occurred only in one patient each (6%). No significant differences were observed in cause-specific survival.
In the elderly, preoperative pulmonary risk is frequently present, and careful perioperative management is needed while paying special attention to pulmonary and cardiovascular complications. However, when the indications for surgery can be strictly determined, an esophagectomy is considered a viable treatment alternative with satisfactory prognosis even in patients 80 years of age and older without any increased morbidity or mortality.
本研究旨在阐明老年食管癌患者（尤其是80岁以上患者）行食管切除术的适应证。
668例经胸段入路行食管切除术的胸段食管癌患者按年龄分为三组，即I组（>80岁，n = 16）、II组（70 - 79岁，n = 158）和III组（≤69岁，n = 494）。I组仅对PS 0或1且心肺功能正常的患者进行手术。
II组和III组术前肺部风险发生率分别为16%和7%（P<0.01）。II组和III组的发病率分别为42%和32%（P<0.05）。肺部并发症发生率分别为18%和10%，心血管并发症发生率分别为11%和4%（P<0.01）。I组的发病率和30天死亡率分别为25%和0%，肺部和心血管并发症各仅发生1例（6%）。特定病因生存率无显著差异。
在老年人中，术前常存在肺部风险，围手术期需要仔细管理，尤其要关注肺部和心血管并发症。然而，当手术适应证能够严格确定时，即使是80岁及以上的患者，食管切除术也被认为是一种可行的治疗选择，预后良好，且发病率和死亡率不会增加。
