Evaluation of surgical treatment for patients with gastric cancer who are over 80 years of age.
Evaluation of surgical treatment for patients with gastric cancer who are over 80 years of age.
复制标题
80岁以上胃癌患者手术治疗的评价
作者：
K. Kitamura;K. Sugimachi;M. Saku
背景/目的
本研究的目的是评估超高龄胃癌患者（≥ 80岁）是否适合行R2/R3（扩大）胃切除术。
方法
该研究评估了1334名在过去15年中接受治疗的胃癌患者，这些患者年龄超过40岁。按年龄分为3组：80岁以上的超高龄患者（A组，n = 60），60-79岁的患者（B组，n = 703），40-59岁的患者（C组，n = 571）。
结果
A组中伴随全身性疾病的发生率高于B组或C组（65% vs. 53.2% vs. 34%）（p <0.0001）。切除率相似（88.3% vs. 93.7% vs. 96.1%），但是，A组中全胃切除术、R2/R3夹层或其他器官联合切除术的发生率远低于其他组（p <0.005）。根治性切除术后患者的生存曲线无显著性差异，但34.4%的超高龄患者死于其他原因，A、B组包括其他原因在内的5年生存率均低于C组（p <0.01）。在A组中，接受R2/R3夹层的患者的术后并发症发生率是接受R0/R1（区域）夹层的患者的2倍，然而，无论是否考虑其他死亡原因，他们的预后也更好。
结论
因此，我们得出结论，R2/R3胃切除术基本上适用于超高龄患者，只要他们表现出良好的风险。但也要考虑短期效果。
BACKGROUND/AIMS
The aim of this study is to evaluate whether super-elderly patients (> or = 80) with gastric cancer may be appropriate candidates for an R2/R3 (extended) gastrectomy.
METHODOLOGY
The study evaluated 1334 patients with gastric cancer treated over the past 15 years, who were over 40 years of age. They were divided into three groups according to age: Super-elderly patients who were over 80 (group A; n=60), those aged 60-79 (group B; n=703) and those aged 40-59 (group C; n=571).
RESULTS
The incidence of concomitant systemic disorders was higher in group A than in either group B or group C (65% vs. 53.2% vs. 34%) (p<0.0001). The resection rates were similar (88.3% vs. 93.7% vs. 96.1%), however, the incidence of a total gastrectomy, an R2/R3 dissection, or a combined resection of other organs was much lower in group A than those in the other groups (p<0.005). The survival curves of patients after a curative resection were not significant, however, 34.4% of the super-elderly patients died of other causes and the 5-year survival rates including other cause of death were poorer in groups A and B than those in group C (p<0.01). In group A, patients receiving an R2/R3 dissection had a two-fold higher incidence of post-operative complications over those receiving an R0/R1 (regional) dissection, however, they also had a better prognosis whether or not other causes of death were considered.
CONCLUSIONS
We, therefore, conclude that an R2/R3 gastrectomy is basically appropriate for super-elderly patients, as long as they demonstrate a good risk. However, the short-term results should also be considered.