Zhou C-J, Chen F-F, Zhuang C-L, Pang W-Y, Zhang F-Y, Huang D-D, Wang S-L, Shen X, Yu Z
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China.
Eur J Surg Oncol. 2016 Feb;42(2):303-11. doi: 10.1016/j.ejso.2015.11.013. Epub 2015 Dec 6.
The aim of this study was to evaluate the short-term safety and long-term benefits of radical gastrectomy for gastric cancer in elderly patients.
A total of 729 patients undergoing gastrectomy for adenocarcinoma between December 2008 and December 2011 were enrolled in this retrospective study. Patients were divided into three groups: young group (<65 years), young-old group (65-79 years) and old-old group (≥80 years).
Lower albumin levels, higher ASA grades, comorbidities, tumors located in the upper third of the stomach and advanced TNM stages were more common in the young-old and old-old age groups. Overall complications increased significantly with advancing age (15.4%, 24.9%, 48.7%, respectively); respiratory complications largely contributed to the dramatic increase. Severe complications were similar between the young and young-old groups (3.9%, 3.7%), but were significantly increased in the old-old group (12.8%). In multivariate analysis, old-old age, multiple comorbidities and no epidural use were strong predictors for overall complications. Both overall survival and disease-specific survival (DSS) rates declined with advancing age. Multivariate analysis showed that old-old age and TNM stage ≥ II were major independent risk factors for the DSS rate. When adjusted for confounding factors, young-old age was not a risk factor. The median survival time for the old-old patients with stage III tumors was 12.9 months.
It is relatively safe and beneficial for young-old patients to undergo radical gastrectomy as the young patients. However, the decision to perform radical gastrectomy for old-old patients with TNM stage III tumors should be made carefully.
本研究旨在评估老年胃癌患者行根治性胃切除术的短期安全性和长期获益。
本回顾性研究纳入了2008年12月至2011年12月期间因腺癌行胃切除术的729例患者。患者分为三组：青年组（<65岁）、中青年组（65 - 79岁）和老年组（≥80岁）。
白蛋白水平较低、美国麻醉医师协会（ASA）分级较高、合并症、肿瘤位于胃上三分之一以及TNM分期较晚在中青年组和老年组中更为常见。总体并发症随年龄增长显著增加（分别为15.4%、24.9%、48.7%）；呼吸系统并发症是导致显著增加的主要原因。青年组和中青年组的严重并发症相似（3.9%，3.7%），但老年组显著增加（12.8%）。多因素分析显示，高龄、多种合并症以及未使用硬膜外麻醉是总体并发症的强预测因素。总生存率和疾病特异性生存率（DSS）均随年龄增长而下降。多因素分析表明，高龄和TNM分期≥II是DSS率的主要独立危险因素。校正混杂因素后，中青年年龄不是危险因素。老年III期肿瘤患者的中位生存时间为12.9个月。
中青年胃癌患者行根治性胃切除术相对安全且有益。然而，对于老年TNM III期肿瘤患者，应谨慎决定是否行根治性胃切除术。
