BACKGROUND: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes. METHODS: Five hundred seventy-seven liver resections (July 1985-July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983-July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older. RESULTS: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5-year survival rate was 35%. No differences were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay for the younger patients (median, 12 days vs. 13 days; p = 0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long-term survival was poorer for the elderly patients, with a 5-year survival rate of 21% compared with 29% for the younger cohort (p = 0.03). CONCLUSIONS: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term survival. Chronological age alone is not a contraindication to liver or pancreatic resection for malignancy.
展开▼
机译:背景:传统上认为肝切除或胰十二指肠切除术在老年人中具有较高的发病率和死亡率。外科和麻醉技术的最新进展,老年患者的增加以及对使用有限的医疗资源的合理性的需求日益增加,促使人们对近期的外科手术结局进行了评估。方法:在部门数据库中,确定了针对转移性结直肠癌进行的577例肝脏切除术(1985年7月至1994年7月)和针对胰腺恶性肿瘤进行的488例胰腺切除术(1983年10月至1994年7月)。将年龄小于70岁的患者的结果与年龄大于或等于70岁的患者的结果进行比较。结果:128例70岁或以上的患者进行肝切除,围手术期死亡率为4%,并发症发生率为42%。住院中位时间为13天,有8%的患者需要入院重症监护病房(ICU)。中位生存期为40个月,5年生存率为35%。老年人和接受肝切除术的年轻患者的结果之间无差异,除了年轻患者的住院时间最短(中位数,12天比13天; p = 0.003)。 138例老年患者的胰腺切除术导致死亡率为6%,并发症发生率为45%。中位住院时间为20天,其中19%的患者需要ICU入院,结果与年轻队列的结果相同。老年患者的长期生存较差,其5年生存率为21%,而年轻队列为29%(p = 0.03)。结论:老年人可以进行大范围的肝脏或胰腺切除术,其发病率和死亡率可以接受,并且可以长期生存。单纯按年龄分类并不是恶性的肝或胰腺切除术的禁忌症。
展开▼