Detillon Deniece D E M A, Veen Eelco J
Department of Surgery, Amphia Hospital, Breda, Netherlands.
Department of Surgery, Amphia Hospital, Breda, Netherlands.
Ann Thorac Surg. 2018 Jan;105(1):287-293. doi: 10.1016/j.athoracsur.2017.07.032. Epub 2017 Nov 11.
Lung cancer is the main cause of cancer-related death in the Netherlands. Surgery offers the best potential cure, but lower rates of surgery are recorded for octogenarians because of concerns regarding morbidity and mortality.
We analyzed the Dutch Lung Surgery Audit database to determine the postoperative outcome of lung cancer resections for patients aged 60 years or more between January 2013 and December 2014. Three groups were compared: patients aged 80 years or more, patients aged 70 to 79 years, and patients aged 60 to 69 years. Multivariable analysis was done of postoperative complications and operative mortality.
In all, 2,133 lung cancer resections were performed, of which 70.5% by video-assisted thoracic surgery. Postoperative complications were observed in 637 patients (29.9%), without any difference among the three age groups (p = 0.278). Factors associated with complications were sex, percentage predicted forced expiratory volume in 1 second, percentage predicted diffusion capacity of lung for carbon monoxide, coronary artery bypass graft, chronic obstructive pulmonary disease, and resection more extensive than limited. The mean operative mortality was 2.1% (44 patients), 6.0% (10 patients) among octogenarians (p < 0.001). Age 80 years or more, percentage predicted forced expiratory volume in 1 second, performance status, and congestive heart failure independently predicted operative mortality.
A higher operative mortality rate was observed among octogenarians, but the incidence of complications was similar in all age groups.
肺癌是荷兰癌症相关死亡的主要原因。手术是最有可能治愈的方法，但由于对发病率和死亡率的担忧，八十多岁老人的手术率较低。
我们分析了荷兰肺手术审计数据库，以确定2013年1月至2014年12月期间60岁及以上肺癌切除患者的术后结果。比较了三组：80岁及以上患者、70至79岁患者和60至69岁患者。对术后并发症和手术死亡率进行了多变量分析。
总共进行了2133例肺癌切除术，其中70.5%通过电视辅助胸腔镜手术进行。637例患者（29.9%）出现术后并发症，三个年龄组之间无差异（p = 0.278）。与并发症相关的因素包括性别、1秒用力呼气量预测值百分比、肺一氧化碳弥散量预测值百分比、冠状动脉搭桥术、慢性阻塞性肺疾病以及切除范围超过局限性切除。平均手术死亡率为2.1%（44例患者），八十多岁老人中为6.0%（10例患者）（p < 0.001）。80岁及以上、1秒用力呼气量预测值百分比、体能状态和充血性心力衰竭独立预测手术死亡率。
八十多岁老人的手术死亡率较高，但所有年龄组的并发症发生率相似。
