Miura Naoko, Kohno Mikihiro, Ito Kensaku, Senba Mayuko, Kajiwara Koutarou, Hamaguchi Naohiko, Makino Hideki, Kanematsu Takanori, Okamoto Tatsuro, Yokoyama Hideki
Department of Surgery, Saiseikai Karatsu Hospital, 817, Motohata-machi, Karatsu, Saga, 847-0052, Japan,
Gen Thorac Cardiovasc Surg. 2015 Jul;63(7):401-5. doi: 10.1007/s11748-015-0546-7. Epub 2015 Apr 14.
As the population ages, the age of patients undergoing thoracic surgery increases, and elderly patients often have more comorbidities than younger patients.
This retrospective study observed preoperative comorbidities, surgical procedures and postoperative morbidity and mortality after lung cancer surgery in patients 80 years of age or older. The medical records of lung cancer patients 80 years of age or older who underwent surgery from January 2003 to December 2012 were reviewed.
There were 49 patients (27 males, 22 females), with a median age of 83 years. Thirty patients underwent major pulmonary resection and 18 patients underwent limited pulmonary resection. The median Charlson comorbidity index was 3. Although approximately two-thirds of the patients (20 patients; 40.8%) experienced some kind of postoperative morbidity, more than 80% of the complications were grade 1 or 2 according to the Clavien-Dindo classification. Cerebrovascular disease and chronic obstructive pulmonary disease were significantly associated with moderate-to-severe complications. Postoperative death was observed in two cases (4.1%). In addition, an increased American Society of Anesthesiologists classification score and past history of myocardial infarction, congestive heart failure and/or diabetes mellitus with end-organ damage were significantly associated with mortality. The overall survival rate was 79.6% at 3 years and 53.1% at 5 years.
Thoracic surgery shows acceptable morbidity and mortality in patients 80 years of age or older. Patients 80 years of age or older should be offered the best treatments, including surgery, with careful patient evaluation and selection.
随着人口老龄化，接受胸外科手术的患者年龄增加，老年患者通常比年轻患者有更多的合并症。
这项回顾性研究观察了80岁及以上患者肺癌手术后的术前合并症、手术方式以及术后发病率和死亡率。回顾了2003年1月至2012年12月期间接受手术的80岁及以上肺癌患者的病历。
共有49例患者（男性27例，女性22例），中位年龄为83岁。30例患者接受了肺大部切除术，18例患者接受了肺局限性切除术。Charlson合并症指数中位数为3。虽然约三分之二的患者（20例；40.8%）出现了某种术后并发症，但根据Clavien-Dindo分类，超过80%的并发症为1级或2级。脑血管疾病和慢性阻塞性肺疾病与中重度并发症显著相关。观察到2例患者术后死亡（4.1%）。此外，美国麻醉医师协会分级评分增加以及有心肌梗死、充血性心力衰竭和/或伴有终末器官损害的糖尿病病史与死亡率显著相关。3年总生存率为79.6%，5年总生存率为53.1%。
胸外科手术在80岁及以上患者中显示出可接受的发病率和死亡率。应向80岁及以上患者提供包括手术在内的最佳治疗，但需对患者进行仔细评估和选择。
