Nieß H, Kleespies A, Andrassy J, Pratschke S, Angele M K, Guba M, Jauch K-W, Bruns C J
Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, LMU München,Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
Chirurg. 2013 Apr;84(4):291-5. doi: 10.1007/s00104-012-2455-y.
The considerable increase of the aged population in western civilisation within the next years will result in a rising incidence of pancreatic cancer. Until the year 2020 an increment of 20 % of patients beyond 65 years old can be anticipated. Therefore, the focus will be on management of old and geriatric surgical patients leading to strategical re-evaluation of surgical indications under critical consideration of feasibility and purpose. Even under modern interdisciplinary therapy concepts the prognosis of ductal adenocarcinoma of the pancreas remains poor with an overall 5-year survival rate of less than 5 %. The surgical resection is still considered as the only potential curative treatment option with extended life expectancy; however, it is technically demanding and furthermore associated with significant morbidity. In particular, the quality of surgery of the now interdisciplinary therapy of pancreatic cancer is markedly improved when performed at a high-volume centres. Until now only a few retrospective data analyses evaluating the perioperative and long-term outcome after pancreatic tumor resections in geriatric patients exist. The available results, however, support radical surgical procedures even beyond the age of 75 years.
在未来几年,西方文明国家老年人口的显著增加将导致胰腺癌发病率上升。预计到2020年,65岁以上患者数量将增加20%。因此,重点将放在老年外科患者的管理上,这将促使在严格考虑可行性和目的的情况下,对外科手术适应症进行战略重新评估。即使在现代多学科治疗理念下,胰腺导管腺癌的预后仍然很差,总体5年生存率不到5%。手术切除仍然被认为是唯一有可能延长预期寿命的治愈性治疗选择;然而,这在技术上要求很高,而且还伴随着显著的发病率。特别是,在高容量中心进行胰腺癌多学科治疗时,手术质量会有显著提高。到目前为止,仅有少数回顾性数据分析评估老年患者胰腺肿瘤切除术后的围手术期和长期结果。然而,现有结果支持即使在75岁以上也可进行根治性手术。