Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
J Geriatr Oncol. 2019 Jul;10(4):598-603. doi: 10.1016/j.jgo.2018.10.012. Epub 2018 Oct 24.
The safety of minimally-invasive (MIG) and open gastrectomy (OG) in the older patients has been demonstrated in several international studies but has not been evaluated in the context of a large, Western population. The objective of this study was to evaluate the safety of gastrectomy by these two approaches among octogenarians in the United States.
The National Cancer Database (2010-2014) was queried for patients with gastric adenocarcinoma who underwent MIG or OG. Disease and treatment characteristics and outcomes were compared across age groups (<65, 65-79, ≥80 years). Multivariable regression analysis was used to identify factors associated with 90-day mortality.
13,845 patients were identified who met study inclusion criteria, of which 2140 patients (16%) were aged ≥80 years. Among octogenarians, MIG was associated with slightly decreased length of stay (11.2 vs 12.7 days, p < .001) compared to OG, with no difference in the rate of margin-positive resections, adequate lymph node sampling, or readmission (p = .30-0.77). 90-day mortality for both OG (17%) and MIG (17.2%) was significantly higher among octogenarians compared to younger patients (p < .001). Treatment at an academic facility was an independent predictor of decreased 90-day mortality among octogenarians (OR 0.534, 95%CI 0.322-0.886, p = .015).
In this Western population, we report comparable oncologic and post-operative outcomes between MIG and OG. However, the overall post-operative mortality rate among octogenarians remains unacceptably high. Better patient selection criteria for surgery and efforts to refer these patients to higher volume, academic facilities should be considered to improve patient outcomes.
几项国际研究已经证明了微创（MIG）和开放式胃切除术（OG）在老年患者中的安全性，但尚未在西方人群的大样本中进行评估。本研究的目的是评估美国 80 岁以上患者接受这两种方法进行胃切除术的安全性。
从 2010 年至 2014 年的国家癌症数据库中检索接受 MIG 或 OG 的胃腺癌患者。比较不同年龄组（<65 岁、65-79 岁、≥80 岁）的疾病和治疗特征及结果。多变量回归分析用于确定与 90 天死亡率相关的因素。
共纳入 13845 例符合研究纳入标准的患者，其中 2140 例（16%）年龄≥80 岁。在 80 岁以上的患者中，与 OG 相比，MIG 术后住院时间略有缩短（11.2 天比 12.7 天，p<.001），但切缘阳性率、充分淋巴结取样率或再入院率无差异（p=.30-0.77）。OG（17%）和 MIG（17.2%）的 80 岁以上患者 90 天死亡率明显高于年轻患者（p<.001）。在 80 岁以上患者中，在学术机构治疗是降低 90 天死亡率的独立预测因素（OR 0.534，95%CI 0.322-0.886，p=0.015）。
在本西方人群中，我们报告了 MIG 和 OG 之间具有可比性的肿瘤学和术后结果。然而，80 岁以上患者的总体术后死亡率仍然高得令人无法接受。应考虑更好的手术患者选择标准，并努力将这些患者转诊至更高容量的学术机构，以改善患者结局。
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