Shiozawa Shunichi, Usui Takebumi, Kuhara Kotaro, Tsuchiya Akira, Miyauchi Tatsuomi, Kono Teppei, Shimojima Yukio, Asaka Shinichi, Yamaguchi Kentaro, Yokomizo Hajime, Shimakawa Takeshi, Yoshimatsu Kazuhiko, Katsube Takao, Naritaka Yoshihiko
Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Anticancer Res. 2017 Apr;37(4):2037-2043. doi: 10.21873/anticanres.11549.
BACKGROUND/AIM: Pancreaticoduodenectomy (PD) treatment outcomes in elderly patients have been reported to be acceptable, but the eligibility criteria are not clear. To elucidate the importance of PD in octogenarians in particular, we set five eligibility criteria for elderly patients based on preoperative cardiac and pulmonary function, nutritional status, daily activity status, and psychological independence status for the first time and evaluated prospectively whether the validity of patient selection was adaptable.
The study population consisted of 222 patients with pancreaticobiliary cancer aged over 70 years. The patients were divided into two groups: 192 patients as septuagenarians and 30 as octogenarians. Postoperative morbidity and long-term outcome were compared between the two groups, and prognostic factors relating to survival time were identified.
Octogenarians had a significantly higher frequency of two or more comorbidities (p<0.0001). The difference in the mortality rates between the two groups was not significant, being 3.3% and 4.2%, respectively. No difference between the two groups was found in overall survival rate, including deaths due to other diseases, for any type of pancreaticobiliary cancer. Independent prognostic factors relating to survival duration were intraoperative blood loss (p=0.0004) and duration of surgery (p=0.0093).
These five eligibility criteria for PD in elderly patients are also satisfactorily applicable to octogenarian patients. These criteria may be helpful when uncertainties arise regarding the selection of PD.
背景/目的：据报道，老年患者胰十二指肠切除术（PD）的治疗效果尚可，但 eligibility criteria 尚不明确。为了特别阐明PD在八旬老人中的重要性，我们首次基于术前心脏和肺功能、营养状况、日常活动状态以及心理独立状态为老年患者设定了五条 eligibility criteria，并前瞻性地评估了患者选择的有效性是否适用。
研究人群包括222例年龄超过70岁的胰胆管癌患者。患者分为两组：192例为七旬老人，30例为八旬老人。比较两组术后发病率和长期结局，并确定与生存时间相关的预后因素。
八旬老人患有两种或更多种合并症的频率显著更高（p<0.0001）。两组死亡率差异不显著，分别为3.3%和4.2%。对于任何类型的胰胆管癌，两组在总生存率（包括因其他疾病导致的死亡）方面均未发现差异。与生存持续时间相关的独立预后因素为术中失血量（p=0.0004）和手术持续时间（p=0.0093）。
老年患者PD的这五条 eligibility criteria 同样令人满意地适用于八旬老人患者。当在PD选择方面存在不确定性时，这些标准可能会有所帮助。
