Schwarz R E, Karpeh M S, Brennan M F
Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, CA, USA.
J Am Coll Surg. 1997 Jan;184(1):9-15.
Variable reports exist about the early and long-term outcome after operative treatment for gastric carcinoma in the elderly. This study was designed to describe perioperative morbidity and factors influencing the length of hospitalization in patients older than 70 years of age in a tertiary care cancer center.
Patient information for a 10-year period, between July 1985 and July 1995, was obtained through a prospective database and chart review. Complications and length of stay were tabulated. Patient-, disease-, and treatment-related factors and their influence on outcome were compared by univariate and multivariate analysis using nonparametric product-limit models.
Of 385 patients aged 71 years or older with gastric adenocarcinoma, 310 underwent resection. Postoperative complications occurred in 47.1 percent. Infectious complications predominated, most frequently involving intra-abdominal and pulmonary sites. Perioperative mortality was 7.1 percent. The median postoperative length of stay was 13 days (95 percent confidence interval 12 to 14 days; 25th percentile, 10 days; 75th percentile, 20 days). Factors independently predicting an increased duration of stay were presence of any complications, the type of resection, site of the primary carcinoma, and presence of postoperative infection. Complications added 30.4 percent of total patient days, or an average of 11.5 hospital days per patient with a complication. Although patients with postoperative complications had inferior overall and disease-specific survival, this was not an independent prognostic variable. Compared with patients younger than 70 years of age, elderly patients had a significantly increased hospital stay.
The single most important factor leading to increased length of hospitalization is the occurrence of any complication. Although complicated by higher morbidity and mortality, the resection of gastric carcinoma in elderly patients can be performed relatively safely and leads to survival that is comparable to younger patients. The findings support careful patient selection and optimal preparation of elderly patients undergoing resection for gastric carcinoma.
关于老年胃癌手术治疗后的早期和长期结果，存在各种不同的报道。本研究旨在描述在一家三级医疗癌症中心中，年龄大于70岁患者围手术期的发病率以及影响住院时间的因素。
通过前瞻性数据库和病历回顾，获取了1985年7月至1995年7月这10年间的患者信息。将并发症和住院时间制成表格。使用非参数乘积限模型，通过单因素和多因素分析比较患者、疾病和治疗相关因素及其对结果的影响。
在385例年龄71岁及以上的胃腺癌患者中，310例接受了手术切除。术后并发症发生率为47.1%。感染性并发症占主导，最常见的累及腹腔内和肺部。围手术期死亡率为7.1%。术后住院时间中位数为13天（95%置信区间12至14天；第25百分位数，10天；第75百分位数，20天）。独立预测住院时间延长的因素包括任何并发症的存在、切除类型、原发性癌的部位以及术后感染的存在。并发症增加了患者总住院天数的30.4%，即每例有并发症的患者平均增加11.5个住院日。虽然术后有并发症的患者总体生存率和疾病特异性生存率较低，但这并非独立的预后变量。与年龄小于70岁的患者相比，老年患者的住院时间显著延长。
导致住院时间延长的最重要单一因素是任何并发症的发生。尽管老年患者胃癌切除手术的发病率和死亡率较高，但仍可相对安全地进行，且生存情况与年轻患者相当。这些发现支持对接受胃癌切除术的老年患者进行仔细的患者选择和优化准备。
