内容紹介
Summary
With the aging population, the number of early gastric cancer patients aged 80 years or older is increasing. We clarified the outcome of gastrectomy among early gastric cancer patients aged 80 years or older and examined the significance of additional gastrectomy for non-curative ESD cases. 1) Surgical outcomes in 90 cases of early gastric cancer patients aged 80 years or older with gastrectomy were analyzed. Gastrectomy was performed for patients up to 88 years of age and 84 cases(93.3%)were pStageⅠA. Three years and 5 years survival rates were 83.9% and 60.4%, respectively. The causes of death included other disease in 28 cases, other cancer in 4 cases, and death associated with hospital stay in 1 case. 2) There were 28 non-curative ESD cases, including 6 T1a, 9 T1b1, and 13 T1b2. Among them, 8 additional gastrectomies were performed, but none were lymph node metastases and cancer residue at the proper muscle layer was identified in only 1 case. Three years and 5 years survival rates of the additional gastrectomy group were 100% and 60%, respectively. Although 2 years survival rate of the group without additional gastrectomy was 83.3%, there were no deaths due to gastric cancer. In elderly patients with early gastric cancer, considering the increasing the proportion deaths due to other diseases and the decreased quality of life after gastrectomy, the usefulness of additional gastrectomy for non-curative ESD is limited.
要旨
80歳以上の早期胃癌に対する胃切除の治療成績を明らかにするとともに,80歳以上のESD非治癒切除症例の追加胃切除の意義を検討した。80歳以上の早期胃癌手術症例90例およびESD後非治癒切除と判定され,経過観察した20例と追加胃切除を施行した8例を分析した。胃切除は88歳まで施行され,84例(93.3%)がpStageⅠAであった。3年生存率83.9%,5年生存率60.4%で,他病死28例,他癌死4例,在院死1例であった。ESD非治癒切除症例はT1a 6例,T1b1 9例,T1b2 13例で,追加胃切除が8例に行われたが癌遺残1例で,リンパ節転移は認めず,3年生存率100%,5年生存率60%であった。経過観察群は2年生存率83.3%で胃癌による死亡は認めなかった。高齢者早期胃癌では他病死比率が増加するため術後のQOLも考慮すると,ESD後の追加切除対象はかなり限定されるであろう。
目次
With the aging population, the number of early gastric cancer patients aged 80 years or older is increasing. We clarified the outcome of gastrectomy among early gastric cancer patients aged 80 years or older and examined the significance of additional gastrectomy for non-curative ESD cases. 1) Surgical outcomes in 90 cases of early gastric cancer patients aged 80 years or older with gastrectomy were analyzed. Gastrectomy was performed for patients up to 88 years of age and 84 cases(93.3%)were pStageⅠA. Three years and 5 years survival rates were 83.9% and 60.4%, respectively. The causes of death included other disease in 28 cases, other cancer in 4 cases, and death associated with hospital stay in 1 case. 2) There were 28 non-curative ESD cases, including 6 T1a, 9 T1b1, and 13 T1b2. Among them, 8 additional gastrectomies were performed, but none were lymph node metastases and cancer residue at the proper muscle layer was identified in only 1 case. Three years and 5 years survival rates of the additional gastrectomy group were 100% and 60%, respectively. Although 2 years survival rate of the group without additional gastrectomy was 83.3%, there were no deaths due to gastric cancer. In elderly patients with early gastric cancer, considering the increasing the proportion deaths due to other diseases and the decreased quality of life after gastrectomy, the usefulness of additional gastrectomy for non-curative ESD is limited.
要旨
80歳以上の早期胃癌に対する胃切除の治療成績を明らかにするとともに,80歳以上のESD非治癒切除症例の追加胃切除の意義を検討した。80歳以上の早期胃癌手術症例90例およびESD後非治癒切除と判定され,経過観察した20例と追加胃切除を施行した8例を分析した。胃切除は88歳まで施行され,84例(93.3%)がpStageⅠAであった。3年生存率83.9%,5年生存率60.4%で,他病死28例,他癌死4例,在院死1例であった。ESD非治癒切除症例はT1a 6例,T1b1 9例,T1b2 13例で,追加胃切除が8例に行われたが癌遺残1例で,リンパ節転移は認めず,3年生存率100%,5年生存率60%であった。経過観察群は2年生存率83.3%で胃癌による死亡は認めなかった。高齢者早期胃癌では他病死比率が増加するため術後のQOLも考慮すると,ESD後の追加切除対象はかなり限定されるであろう。