Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, Jeollanam-do, Korea.
Ann Surg Oncol. 2010 Jun;17(6):1589-96. doi: 10.1245/s10434-010-0916-4. Epub 2010 Jan 23.
As a life expectancy increases, the proportion of aged patients diagnosed with gastric cancer has increased over the past decades, but the optimal surgical approach to these patients remains a dilemma because of the presumed risk associated with extended surgery.
A total of 383 consecutive patients who underwent gastrectomy with D2 lymph node dissection in 2008 and 2009 were enrolled onto this study. Patients were divided into two age groups (<70 vs. > or =70 years) and were prospectively evaluated with respect to postoperative complications and hospital courses.
The cohort consisted of 101 elderly and 282 nonelderly patients. No statistically significant differences were evident between the two groups with respect to clinicopathological parameters and operations performed, except for preoperative comorbidity rates and mean American Society of Anesthesiologists scores. Surgical complication rates in the elderly and nonelderly groups were 18.8 and 17.4%, respectively (P = 0.746), and medical complication rates were 5.0 and 1.8%, respectively (P = 0.137). The two groups were not statistically significantly different in terms of mean length of hospital stays, times to diet start, or required transfusion. Multivariate analysis showed that body mass index, male sex, and distal pancreatectomy were independent risk factors of a surgical complication, and that comorbidity and operating time were independently associated with a medical complication.
This study shows that age neither increased postoperative morbidity nor negatively affected hospital courses after gastrectomy with D2 lymph node dissection. Accordingly, chronologic age alone should not preclude standard gastrectomy with extended lymph node dissection in gastric carcinoma.
随着预期寿命的延长，过去几十年来被诊断患有胃癌的老年患者比例有所增加，但由于延长手术相关的假定风险，这些患者的最佳手术方法仍然存在困境。
本研究共纳入 2008 年和 2009 年接受 D2 淋巴结清扫术的 383 例连续胃癌患者。将患者分为两组（<70 岁和≥70 岁），并前瞻性评估术后并发症和住院过程。
该队列包括 101 名老年患者和 282 名非老年患者。两组在临床病理参数和手术操作方面无统计学差异，除术前合并症发生率和平均美国麻醉医师协会评分外。老年组和非老年组的手术并发症发生率分别为 18.8%和 17.4%（P=0.746），医疗并发症发生率分别为 5.0%和 1.8%（P=0.137）。两组在平均住院时间、开始饮食时间和需要输血方面无统计学差异。多因素分析显示，体重指数、男性和胰体尾切除术是手术并发症的独立危险因素，而合并症和手术时间与医疗并发症独立相关。
本研究表明，年龄既不会增加术后发病率，也不会对 D2 淋巴结清扫术后的住院过程产生负面影响。因此，单纯年龄不应排除标准的胃癌根治术和扩大淋巴结清扫术。
