Hikage Makoto, Tokunaga Masanori, Makuuchi Rie, Irino Tomoyuki, Tanizawa Yutaka, Bando Etsuro, Kawamura Taiichi, Terashima Masanori
Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Department of Surgery, Sendai City Hospital, Sendai, Miyagi, Japan.
Surg Today. 2018 Aug;48(8):773-782. doi: 10.1007/s00595-018-1651-x. Epub 2018 Mar 13.
Whether or not gastrectomy is feasible for very elderly gastric cancer patients is unclear. This study aimed to clarify the feasibility and safety of surgical treatment for patients in this age group.
The study included 55 very elderly patients with resectable gastric cancer who underwent gastrectomy (≥ 85 years of age; very-E group). The surgical outcomes were compared with those of 611 elderly patients (75-84 years old; E group).
Female sex, a poor physical and performance status, and a low serum albumin level patients were more frequent in the very-E group than in the E group. Lymphadenectomy was less aggressive in the very-E group than in the E group (P < 0.001). The overall postoperative complication rate was not significantly different between the groups (46 vs 33%; P = 0.073). A multivariate analysis to predict the overall survival identified male sex (hazard ratio 1.75, 95% confidence interval 1.30-2.36), low body mass index (2.19, 1.52-3.16), poor performance status (2.14, 1.60-2.86), low serum albumin level (1.84, 1.37-2.48), and advanced tumor stage (1.71, 1.29-2.27) but not age (1.31, 0.84-2.03) as independent prognostic factors.
Chronological age alone is not a contraindicative factor for gastrectomy in very elderly patients.
对于高龄胃癌患者而言，胃切除术是否可行尚不清楚。本研究旨在阐明该年龄组患者手术治疗的可行性和安全性。
本研究纳入了55例接受胃切除术的高龄可切除胃癌患者（≥85岁；高龄组）。将手术结果与611例老年患者（75 - 84岁；老年组）的结果进行比较。
高龄组女性、身体和功能状态较差以及血清白蛋白水平较低的患者比老年组更为常见。高龄组的淋巴结清扫不如老年组积极（P < 0.001）。两组的总体术后并发症发生率无显著差异（46%对33%；P = 0.073）。一项预测总生存期的多因素分析确定男性（风险比1.75，95%置信区间1.30 - 2.36）、低体重指数（2.19，1.52 - 3.16）、功能状态差（2.14，1.60 - 2.86）、低血清白蛋白水平（1.84，1.37 - 2.48）和肿瘤晚期（1.71，1.29 - 2.27）为独立预后因素，而年龄不是（1.31，0.84 - 2.03）。
仅按实足年龄而言，高龄患者行胃切除术并非禁忌因素。
