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老年胃癌患者胃切除术后的结局

Postoperative gastrectomy outcomes in octogenarians with gastric cancer.

作者信息

Mikami Jota, Kurokawa Yukinori, Miyazaki Yasuhiro, Takahashi Tsuyoshi, Yamasaki Makoto, Miyata Hiroshi, Nakajima Kiyokazu, Takiguchi Shuji, Mori Masaki, Doki Yuichiro

机构信息

Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

出版信息

Surg Today. 2015 Sep;45(9):1134-8. doi: 10.1007/s00595-014-1087-x. Epub 2014 Nov 22.

Abstract

PURPOSE

It is controversial whether the treatment strategy for gastric cancer should be different for elderly patients. We herein evaluated the feasibility of gastrectomy and the risk factors for postoperative complications in octogenarians with gastric cancer.

METHODS

We retrospectively collected data on 441 consecutive patients who underwent total or subtotal gastrectomy for gastric cancer. We divided all of the patients into two groups: the octogenarian group (n = 47), consisting of patients aged 80-89 years, and the younger group (n = 394), consisting of patients under 80 years of age.

RESULTS

The postoperative complication rate was 23.1% (91/394) in the younger group and 36.2% (17/47) in the octogenarian group (P = 0.049). Octogenarian patients had significantly lower preoperative serum albumin levels (P < 0.001) and higher ASA scores (P < 0.001). Although the rate of each major complication was similar between the two groups, there was a trend toward a higher rate of other miscellaneous complications, mostly non-surgical complications, in the octogenarian group (P = 0.077). A multivariate analysis of the patients in the octogenarian group revealed that only total gastrectomy was a significant risk factor for postoperative complications (P = 0.035).

CONCLUSION

Octogenarian patients with gastric cancer experienced more complications than younger patients. Therefore, closer monitoring is needed for octogenarian patients who will receive total gastrectomy.

摘要

目的

老年胃癌患者的治疗策略是否应有所不同存在争议。我们在此评估了胃癌老年患者行胃切除术的可行性及术后并发症的危险因素。

方法

我们回顾性收集了441例因胃癌接受全胃或次全胃切除术的连续患者的数据。我们将所有患者分为两组:老年组(n = 47),由80 - 89岁的患者组成;年轻组(n = 394),由80岁以下的患者组成。

结果

年轻组术后并发症发生率为23.1%(91/394),老年组为36.2%(17/47)(P = 0.049)。老年患者术前血清白蛋白水平显著较低(P < 0.001),ASA评分较高(P < 0.001)。虽然两组各主要并发症的发生率相似,但老年组其他杂项并发症(大多为非手术并发症)的发生率有升高趋势(P = 0.077)。对老年组患者进行多因素分析显示,只有全胃切除术是术后并发症的显著危险因素(P = 0.035)。

结论

胃癌老年患者比年轻患者经历更多并发症。因此,对于将接受全胃切除术的老年患者需要更密切的监测。

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