Mueller Herwart, Hahn Michal, Simsa Jaromir
Department of Surgical Oncology, Hospital Hammelburg, Germany.
Hepatogastroenterology. 2008 Nov-Dec;55(88):2005-11.
BACKGROUND/AIMS: Cytoreductive surgery and intraperitoneal hyperthermic chemoperfusion (HIPEC) is an aggressive treatment for patients with peritoneal malignancies. While promising, this therapeutic approach is still associated with significant morbidity and mortality. Surgical risk in elderly patients is even higher, since these people suffer from frequent comorbidities, resulting in poorer performance status. Whether this type of major cancer surgery is feasible in elderly patients is an ongoing question.
Retrospective analysis of elderly patients, undergoing cytoreductive surgery during a period of three years in one centre. Criteria of patients' eligibility were peritoneal carcinomatosis of different origin, age > 65 years, good general status, no extra-abdominal extension and no evidence of bowel obstruction. To reduce morbidity of surgical procedure special perioperative management program including intensified warming management, intra-operative fluid restriction, control of hyperglycaemia, increase of the tissue oxygenation, restriction of blood loss and adenosine receptor activation was employed.
Between January 2004 and January 2007, 47 cytoreductive interventions have been carried out in 44 patients aged older than 65 years at the Department for Surgical Oncology KKH Hammelburg. Mean age of patients in this group was 71 years (min. 65 years, max 82 years). Mean duration of surgery was 5.3 hours (SD = 1.59; range 3.0 to 8.5 hours). Mean duration of the hospital stay was 19.3 days (SD = 9.55, range 11 to 58 days). The frequency of grade 3 and 4 complications was 17.0%. There was no postoperative death registered within the 30 days after surgery (30-days mortality rate 0%).
Incorporating new strategies to reduce morbidity makes aggressive cytoreduction procedure feasible in the majority of elderly patients. Age and advanced peritoneal malignancy should not preclude patients from the maximal surgical effort.
背景/目的：细胞减灭术及腹腔内热灌注化疗（HIPEC）是针对腹膜恶性肿瘤患者的一种积极治疗方法。尽管前景乐观，但这种治疗方法仍伴有显著的发病率和死亡率。老年患者的手术风险甚至更高，因为这些人常伴有多种合并症，导致身体状况较差。这种大型癌症手术在老年患者中是否可行仍是一个悬而未决的问题。
对在一个中心三年内接受细胞减灭术的老年患者进行回顾性分析。患者入选标准为不同来源的腹膜癌、年龄>65岁、一般状况良好、无腹部外转移且无肠梗阻证据。为降低手术并发症发生率，采用了特殊的围手术期管理方案，包括强化保暖管理、术中液体限制、高血糖控制、组织氧合增加、失血限制及腺苷受体激活。
2004年1月至2007年1月期间，哈姆尔堡市立医院外科肿瘤学部对44例年龄大于65岁的患者进行了47次细胞减灭干预。该组患者的平均年龄为71岁（最小65岁，最大82岁）。平均手术时长为5.3小时（标准差=1.59；范围3.0至8.5小时）。平均住院时长为19.3天（标准差=9.55，范围11至58天）。3级和4级并发症发生率为17.0%。术后30天内未记录到术后死亡（30天死亡率0%）。
采用新策略降低发病率使积极的细胞减灭术在大多数老年患者中可行。年龄和晚期腹膜恶性肿瘤不应阻碍患者接受最大程度的手术治疗。
