70岁及以上高龄食管、贲门癌手术治疗进展

IMPROVEMENT OF SURGICAL OUTCOME IN GERIATRIC PATIENTS OVER 70 WITH CANCERS OF THE ESOPHAGUS AND CARDIA

目的探讨高龄食管贲门癌患者的手术治疗问题。方法和结果收治７０岁及以上高龄食管、贲门癌患者１１９例，其中前６年５４例，后４年６５例。后期患者中、晚期（Ⅲ、Ⅳ期）比例高于前期，后期Ⅰ、Ⅱ期肿瘤根治性切除率显著较前期提高（９１．７％和６７．７％，Ｐ＜０．０５），Ⅲ、Ⅳ期病例间无差异。两组术后并发症无差异，但后期住院死亡率较前期明显降低（１８．５％和３８．９％，Ｐ＜０．０５）。结论对高龄食管、贲门癌患者的手术指征应根据其肿瘤分期和全身情况而定。

PURPOSE The general dysfunction of organs as well as a much lower level of stress,immune and metabolic reactions in geriatric patients with esophageal and cardiac cancers make it difficult to carry out surgical treatment in this population. METHODS AND RESULTS 119 patient over 70 years of age underwent operations during the past 10 years,among which 54 were treated in the first 6 years while 65 in the last 4 years.Mean age of the patients was 73 years.The ratio of mid to late stage cases of the latter group was higher than that of the former group.Comparing the outcome of the operations,radical resection rate of early stage (Ⅰ、Ⅱ) tumors was significantly higher in the latter group than that in the former one (91 7% vs 67 7%, P <0 05),but not that of the mid and late stage cases.Although postoperative complications were similar in these two periods,mortality rare during hospital stay was markedly reduced in the latter group (18 5% vs 38 9%, P <0 05). CONCLUSIONS Owing to the improvement of surgical skills along with the optimization of periope rative management,the outcome of surgical intervention in geriatric patients was significantly improved with a reduction of more than half in operative mortality and a two fold increase in radical resection rate in early stage tumors.However,the general outcome is still far from satisfactory compared to the overall population of esophageal carcinoma.Thus we conclude that the selection of surgical therapy should be considered with extreme caution according to the tumor stage and the general condition of each indivicual.