Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
Nagoya J Med Sci. 2021 May;83(2):239-250. doi: 10.18999/nagjms.83.2.239.
The purpose of this study is to clarify the survival benefit and acceptable extent of surgery for very elderly patients with pancreatic cancer. Patients (n=55) ≥80 years with resectable pancreatic cancer were studied. 29 underwent pancreatectomy, 16 underwent chemotherapy, and 10 received best supportive care. Uni and multivariate analysis were performed to explore predictive factors for overall survival (OS) with surgery and chemotherapy (n=45). Postoperative survival of PD (pancreatoduodenectomy) and DP (distal pancreatectomy) and of PD-PVR (PD with portal vein resection) and PD were compared. OS was equivalent with surgery and chemotherapy (median survival time [MST]; 685 vs. 626 days, respectively; p=0.057); 6 patients surivived ≥3 years after surgery. Pancreatectomy was not a prognostic factor. Survival was significantly worse with PD-PVR than with PD, but equivalent with PD and DP. Within 2 years after PD-PVR, 8 patients have died. Surgery was not a positive prognostic factor for very elderly patients with pancreatic cancer, but was the sole chance for survival ≥3 years. Indication for PD-PVR for very elderly patients should be determined more cautiously compared with that for non-elderly patients.
本研究旨在阐明高龄胰腺癌患者手术治疗的生存获益和可接受程度。研究纳入了 55 例年龄≥80 岁、可切除的胰腺癌患者。29 例行胰十二指肠切除术，16 例行化疗，10 例接受最佳支持治疗。对行手术和化疗（n=45）的患者进行单因素和多因素分析，以探讨总生存（OS）的预测因素。比较 PD（胰十二指肠切除术）和 DP（胰体尾切除术）、PD-PVR（PD 联合门静脉切除术）和 PD 的术后生存情况。手术和化疗的 OS 相当（中位生存时间[MST]；分别为 685 天和 626 天；p=0.057）；6 例患者手术后生存≥3 年。胰十二指肠切除术不是预后因素。PD-PVR 的生存显著差于 PD，但与 PD 和 DP 相当。PD-PVR 后 2 年内，8 例患者死亡。手术不是高龄胰腺癌患者的阳性预后因素，但却是生存≥3 年的唯一机会。与非老年患者相比，高龄患者行 PD-PVR 的适应证应更慎重。
