Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
World J Surg. 2010 May;34(5):1015-21. doi: 10.1007/s00268-010-0467-7.
Palliative resection for noncurable gastric cancer remains controversial, especially in the elderly. This retrospective study was designed to elucidate the clinicopathological factors and operative outcome in patients undergoing palliative gastric resection.
From January 1988 to December 2008, 365 patients received palliative gastrectomy while 151 underwent exploratory laparotomy or gastrojejunostomy for noncurative gastric cancer at the Department of Surgery, Taipei Veterans General Hospital. Among the 365 patients, 182 patients (Group A) were aged 70 or less and 183 patients (Group B) were older than 70 years of age. Clinicopathological characteristics and surgical morbidity and mortality were analyzed.
The overall survival of patients who underwent resection was 10.2 months and that of patients without resection 4.48 months (p < 0.001). Compared to Group B, Group A patients were predominantly female (p < 0.001), had more advanced Borrmann-type tumors (p = 0.004), more diffuse type of Lauren classification (p < 0.001), and poorer cell differentiation (p < 0.001). The median overall survival was 10.5 months in Group A and 9.7 months in Group B (p = 0.854). The surgical morbidity was significant higher if the patients had comorbidity (p = 0.028). Both surgical morbidity (13.8% vs. 26.8%, p = 0.028) and mortality (0.5% vs. 6.0%, p < 0.0001) were significantly higher in Group B.
Gastric cancer is less aggressive in the elderly. Palliative gastrectomy can be performed in both younger and older patients, but younger patients tolerate surgery better. More attention should be paid to the perioperative care of the elderly.
对于无法治愈的胃癌，姑息性切除术仍存在争议，尤其是在老年人中。本回顾性研究旨在阐明接受姑息性胃切除术患者的临床病理因素和手术结果。
1988 年 1 月至 2008 年 12 月，外科部门对 365 名患有无法治愈胃癌的患者进行了姑息性胃切除术，而对 151 名患者进行了剖腹探查术或胃空肠吻合术。在 365 名患者中，182 名患者（A 组）年龄在 70 岁以下，183 名患者（B 组）年龄在 70 岁以上。分析了临床病理特征和手术发病率和死亡率。
接受切除术的患者总体生存率为 10.2 个月，未接受切除术的患者为 4.48 个月（p<0.001）。与 B 组相比，A 组患者主要为女性（p<0.001），具有更晚期的 Borrmann 型肿瘤（p=0.004），更弥漫性的 Lauren 分类（p<0.001）和更差的细胞分化（p<0.001）。A 组的中位总生存期为 10.5 个月，B 组为 9.7 个月（p=0.854）。如果患者存在合并症，则手术发病率明显更高（p=0.028）。B 组的手术发病率（13.8%比 26.8%，p=0.028）和死亡率（0.5%比 6.0%，p<0.0001）均明显更高。
老年人的胃癌侵袭性较小。姑息性胃切除术可在年轻和老年患者中进行，但年轻患者的手术耐受性更好。应更加关注老年人的围手术期护理。
