80歳以上の高齢者胸部食道癌手術症例の治療成績

type:Departmental Bulletin Paper

【はじめに】超高齢社会が到来し高齢食道癌患者も増加している。食道癌手術は高侵襲で高齢者には併存疾患も多く、80歳以上の手術適応はより慎重な判断を要するため、当科での成績を基にその妥当性について考察する。【対象】2014年10月から2021月7月に手術を施行した80歳以上の食道癌8例の成績を検討した。当科では低侵襲を目指した胸腔鏡手術、当日抜管、翌日の離床を試みている。全例栄養瘻を造設し翌日より経腸栄養を開始している。【結果】80歳以上の食道癌は8例(男性7例、女性1例)、術前Performance status (PS)は全例0。全例併存疾患あり。腫瘍主占拠部位は胸部上部:1例、中部:4例、下部:3例。臨床病期はStage I:1例、Stage III:7例。全例で胸腔鏡下食道亜全摘、胸骨後胃管再建、開胸移行なし。リンパ節郭清範囲は2領域5例、3領域3例。手術時間中央値415分、出血量中央値203ml。術後合併症は縫合不全2例、肺炎3例、反回神経麻痺1例、せん妄1例、非閉塞性腸管虚血での在院死1例。術後在院日数中央値25日。生存退院7例中5例は同居家族のサポートのもと自宅退院、2例は独居であったが訪問看護を導入し自宅退院可能であった。【結語】一般的に食道癌手術は高度侵襲を伴う治療だが、80歳以上の高齢者でも家族の協力や社会的サービスなど在宅支援の充実により自宅退院が可能であった。高齢者は高率に併存疾患を有するため重篤な合併症を発症すると救命困難となる可能性があり、手術適応は慎重な判断を要する。

Background: The elderly patient with esophageal cancer is increasing. The surgical indications for esophageal cancer in elderly patients over 80 years old requires more careful judgement, because surgical resection of esophageal cancer is highly invasive and the elderly have many comorbidities.Method: We evaluated the surgical outcomes in 8 patients of esophageal cancer over 80 who underwent esophagectomy between October 2014 and July 2021. As perioperative management, thoracoscopic surgery aimed at minimally invasive, extubation on POD（postoperative day）0 were attempted. In all cases, we created transgastric jejunostomy and started enteral nutrition on POD1 for early recovery of intestinal peristalsis and suppression of increased catabolism.Results: There were 8 patients of esophageal cancer (7 males, 1 female), and preoperative performance status (PS) was 0 in all cases. The clinical stage was as follows: one case in Stage I, 7 cases in Stage III. All patients underwent thoracoscopic esophagectomy, posterior sternal gastric tube reconstruction, and no open chest transition. The lymph node dissection was as follows: two fields in 5 cases and three fields in 3 cases. Median operation time was 415 minutes, median intraoperative blood loss was 203 ml. Seven patients have some comorbidities. Postoperative complications were observed as follows: two cases of anastomotic leakage, 3 cases of pneumonia, 1 case of recurrent nerve palsy, and 1 case of hospital death due to non-occlusive intestinal ischemia, respectively. Median postoperative hospital stay was 25 days. Of the 7 patients who were discharged alive, 5 were discharged home with the support of their family, and 2 were discharged home with the using of home nursing.Conclusions: In the elderly with esophageal cancer, careful judgement of surgical resection was necessary, due to high rate of postoperative mortality and morbidity. Support of family or social services was necessary for elderly patients over 80 years old.