Alexiou C, Beggs D, Salama F D, Brackenbury E T, Morgan W E
Thoracic Surgery Unit, Nottingham City Hospital, Nottingham, United Kingdom.
J Thorac Cardiovasc Surg. 1998 Oct;116(4):545-53. doi: 10.1016/S0022-5223(98)70159-X.
Our aim was to compare the outcome of esophageal resection for carcinoma in elderly patients (aged over 70 and over 80 years) with that of younger patients managed within a single specialist thoracic surgery unit.
Between January 1987 and November 1997, 523 patients underwent esophagectomy for carcinoma in the Nottingham City Hospital Thoracic Surgery Unit. The patients were divided into 3 groups by age: group I, under 70 years (n = 337); group II, 70 to 79 years (n = 150), and group III, 80 to 86 years (n = 36). These groups were compared with regard to preoperative medical status, operability and resectability, complications, operative mortality, and longterm survival.
Patients in groups II (6.0%) and III (2.8%) had fewer preexisting respiratory problems than patients in group I (12.5%), and the patients in group III had fewer preexisting cardiovascular problems (16.7%) than patients in groups I (25.2%) and II (32.7 %). Although patients in group III were generally less likely to have operable lesions (64.3%), no significant differences in resectability rate were detected among the 3 groups (80.8%, 77.7%, and 80%). Elderly patients (groups II and III) had a higher incidence of overall (34% and 36.1%), respiratory (24.7% and 19.4%), and cardiovascular (7.3% and 11.1%) complications than those aged under 70 years (24.6%, 16.3%, and 2.1%, respectively). However, operative mortality (4.7%, 6.7%, and 5.6%) and 5-year survivals inclusive of operative mortality (25.1%, 21.2%, and 19.8%) were similar among the 3 groups.
Accumulated experience in all aspects of perioperative management may account for a low hospital mortality in elderly patients despite a greater operative risk. The survival benefit is similar to that in the younger age groups, enforcing the view that esophagectomy within specialist thoracic units can be safely offered (in appropriately selected patients) with acceptable long-term survival in all age groups.
我们的目的是比较老年患者（年龄超过70岁和80岁以上）与在单一专科胸外科接受治疗的年轻患者食管癌切除的结果。
1987年1月至1997年11月期间，523例患者在诺丁汉市医院胸外科接受了食管癌切除术。患者按年龄分为3组：I组，70岁以下（n = 337）；II组，70至79岁（n = 150），III组，80至86岁（n = 36）。比较这些组在术前医疗状况、可手术性和可切除性、并发症、手术死亡率和长期生存率方面的情况。
II组（6.0%）和III组（2.8%）患者术前存在的呼吸问题少于I组患者（12.5%），III组患者术前存在的心血管问题（16.7%）少于I组（25.2%）和II组（32.7%）患者。尽管III组患者通常更不可能有可手术的病变（64.3%），但3组之间的可切除率无显著差异（80.8%、77.7%和80%）。老年患者（II组和III组）总体并发症（34%和36.1%）、呼吸并发症（24.7%和19.4%）和心血管并发症（7.3%和11.1%）的发生率高于70岁以下患者（分别为24.6%、16.3%和2.1%）。然而，3组之间的手术死亡率（4.7%、6.7%和5.6%）以及包括手术死亡率在内的5年生存率（25.1%、21.2%和19.8%）相似。
围手术期管理各方面的积累经验可能是老年患者医院死亡率低的原因，尽管手术风险更大。生存获益与年轻年龄组相似，这强化了这样一种观点，即在专科胸外科单位进行食管癌切除术（在适当选择的患者中）可以安全进行，所有年龄组都能获得可接受的长期生存。
