Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, National Taiwan University College of Medicine, Taipei, 10002, Taiwan, ROC.
World J Surg. 2010 Dec;34(12):2945-52. doi: 10.1007/s00268-010-0759-y.
Although pancreaticoduodenectomy (PD) provides the best chance of survival for elderly patients with ampullary carcinoma, it is associated with considerable surgical risk. The aim of the present study was to compare the benefits and risks of pancreaticoduodenectomy as a treatment of ampullary carcinoma between young and elderly patients.
We retrospectively reviewed the medical records of 171 consecutive patients treated at our hospital. Comparison of the biological aggressiveness of ampullary cancer between old and younger patients was also performed by immunohistochemical study of several prognostic biological markers, including MUC1, MUC2, CK17, and CDX2.
For patients in whom ampullary carcinoma was presumed resectable preoperatively, actuarial survival was significantly poorer in 55 elderly patients because 9 of them did not have PD (the other 46 had PD) than in 101 younger patients (all had PD). Multivariate analysis indicated that PD was the only independent prognostic factor; age was not. There were no significant differences in MUC1, CK17, MUC2, and CDX2 immunohistochemical staining of ampullary carcinomas between elderly and young patients. In spite of increased co-morbidities, PD could be performed as safely in elderly patients as in young patients. After PD, the actuarial survival was similar between old and young patients.
Our data support the conclusion that ampullary cancers in elderly patients should be treated as aggressively as in younger patients.
尽管胰十二指肠切除术（PD）为壶腹癌老年患者提供了最佳的生存机会，但它与相当大的手术风险相关。本研究旨在比较 PD 作为壶腹癌年轻和老年患者治疗方法的益处和风险。
我们回顾性分析了我院 171 例连续患者的病历。通过对包括 MUC1、MUC2、CK17 和 CDX2 在内的几种预后生物标志物的免疫组织化学研究，比较了老年和年轻患者壶腹癌的生物学侵袭性。
对于术前被认为可切除的壶腹癌患者，55 名老年患者的总生存率明显较差，因为其中 9 名患者未接受 PD（其他 46 名患者接受了 PD），而 101 名年轻患者均接受了 PD）。多变量分析表明 PD 是唯一独立的预后因素；年龄不是。老年和年轻患者壶腹癌的 MUC1、CK17、MUC2 和 CDX2 免疫组织化学染色无显著差异。尽管合并症增加，但 PD 可在老年患者中安全进行，与年轻患者相同。PD 后，老年患者和年轻患者的总生存率相似。
我们的数据支持这样的结论，即老年患者的壶腹癌应像年轻患者一样积极治疗。
