Ergebnisse der chirurgischen Therapie des Magencarcinoms beim älteren Menschen

Abstract

In our hospital 35% of the patients undergoing resection for gastric carcinoma are over 70 years old. This group was divided into three age groups; clinico-pathological features, operative morbidity and mortality as well as long-term prognosis were compared with findings taken from a control group of subjects under 70 years old. No differences were noted in the distribution of the UICC stages and the incidence of early gastric cancer. The number of subtotal gastric resections was significantly higher in older patients. During the past 10 years the perioperative morbidity and mortality rates have decreased markedly and only minor differences in comparison with the control group have been recorded. However, the 5-year survival rate was significantly lower in the age group above 80 years old (13.7%) than in the control group (48.7%). Univariate analysis of prognostic factors showed the UICC stage, lymph node metastases, resection line involvement and the patient's age to be of significance. In contrast, in the multivariate analysis age was not of prognostic value.

Resectable Upper Third Gastric Carcinoma With D2 Lymph Node Dissection

“…However, several retrospective studies have demonstrated that DG offered a significantly better survival rate than TG (Gennari, Bozzetti et al, 1986, Launois, Cardin et al, 1991, Robertson, Chung et al, 1994. Moreover, Davies et al, (Davies, Johnston et al, 1998) and Jentschura, Winkler et al, (1997) reported that at one year after surgery, DG patients had a significantly better quality of life than TG patients.…”

Postoperative Adjuvant Therapy Is an Important Factor in Surgical Management of Resectable Distal Gastric Carcinoma With D2 Lymph Node Dissection

“…However, several retrospective studies (Gennari, Bozzetti et al, 1986, Launois, Cardin et al, 1991, Robertson, Chung et al, 1994 demonstrated that DG offered a significantly better survival rate than TG. On the other hand, Davies et al, (Davies, Johnston et al, 1998) and Jentschura et al, (Jentschura, Winkler et al, 1997) reported that at one year after surgery, DG patients had a significantly better quality of life than TG patients. The QOL ANNALS OF Cancer Research and Therapy of patients who underwent subtotal gastrectomy was also significantly better after surgery than before, whereas the QOL of the TG group was not significantly better after the operation than before it (Buhl, Lehnert et al, 1995, Jentschura, Winkler et al, 1997, Svedlund, Sullivan et al, 1997, Davies, Johnston et al, 1998.…”

“…On the other hand, Davies et al, (Davies, Johnston et al, 1998) and Jentschura et al, (Jentschura, Winkler et al, 1997) reported that at one year after surgery, DG patients had a significantly better quality of life than TG patients. The QOL ANNALS OF Cancer Research and Therapy of patients who underwent subtotal gastrectomy was also significantly better after surgery than before, whereas the QOL of the TG group was not significantly better after the operation than before it (Buhl, Lehnert et al, 1995, Jentschura, Winkler et al, 1997, Svedlund, Sullivan et al, 1997, Davies, Johnston et al, 1998. Chareton, Landen et al, (1996) andFuchs, Thiede et al, (1995) also failed to demonstrate that the reconstruction of the duodenal passage was a significant predictor of long-term survival, although several studies have proposed that the theoretical advantages of this surgical procedure are that patients will have a significantly better life quality, higher body weight, and better physiologic regulation of gastrointestinal hormones (Del Gaudio, Marzo et al, 1991, Schwarz, Buchler et al, 1996.…”

“…Although many studies have attempted to determine the minimal amount of gastric resection followed by duodenal food passage reconstruction (DFPR), the theoretical advantage of this minimalist approach has not been confirmed (Espat and Karpeh 1998). As for operating time, infra-and post-operative complications, patient body weight, functional assessment, and quality of life, the minimal gastric resection followed by DFPR produced better outcomes than did extensive gastric resection without DFPR (Buhl, Lehnert et al, 1995, Jentschura, Winkler et al, 1997, Svedlund, Sullivan et al, 1997, Davies, Johnston et al, 1998. The long-term consequences of gastrectomy and of different reconstructive techniques are still a matter of controversy.…”

Chirurgie des Magenkarzinoms – gibt es Grenzen im Alter?

“…dem Ausmaß der chirurgischen Behandlung vermehrt in der Diskussion, umso mehr, da sehr unterschiedliche Ergebnisse -vor allem aus retrospektiven, unizentrischen Analysen aus der westlichen Welt und Asien, speziell Japan -vorgelegt wurden. Auch die Definition «alter Patient» ist nicht einheitlich; neben Angaben der WHO, nach denen ein Patient, der älter als 65 Jahre ist, als alt definiert wird, finden sich auch Angaben für diese Altersschwelle von 70, 75 oder mehr Lebensjahren, wobei dann auch von sehr alten Patienten gesprochen wird [2,[7][8][9][10]. Weitgehende Übereinkunft besteht allerdings darin, dass zur Indikationsstellung der verschiedenen Operationen wie auch der multimodalen Therapieansätze nicht das chronologische, sondern vielmehr das biologische Alter als Summation aller Begleiterkrankungen und Risikofaktoren einschließlich psychosozialer Aspekte ausschlaggebend ist.…”