高齢者消化管癌の特徴―大腸癌の臨床的特徴

The Clinical Features of Colorectal Cancer in the Elderly

要旨　当科で治療が行われた75歳以上の大腸癌375病変を高齢者群，75歳未満の大腸癌1,068病変を対照群として，臨床病理学的に検討した．高齢者群では女性の割合，右側大腸癌の割合，併存症率，重複癌率が有意に高かった．根治度に差はなかったが，高齢者群で郭清度は低く，手術時間も短かった．さらに高齢者群では術後合併症，特にせん妄と呼吸器系の発症率が高く，術後在院日数も長かった．予後はStage II，IVで高齢者群が不良であり，他病死の割合が高かった．術前には，併存症や重複癌の有無の検査を行ったうえで治療方針を慎重に決定し，可能ならば根治度を落とさない手術を行い，術後はせん妄や肺炎などの合併症に十分な注意を払う必要がある．

　In order to clarify the clinicopathological features and the surgical treatment of colorectal cancer in the elderly, we studied 375colorectal cases aged 75（the elderly）and over 1,068cases aged under 75（the non-elderly）. In the elderly group, the rates of female patients, right colon cancers, pre-existing comorbidities and multiple primary cancers were significantly higher than those in the non-elderly group. In the elderly group the degree of lymph node dissection was lower and the operative time was shorter than that in the non-elderly group, but no significant difference was observed in the curability rate between the two groups. Furtheremore, in the elderly group the rates of postoperative morbidities, especially delirium and respiratory complications were significantly higher, length of postoperative hospital stay was longer, overall survival of stage 2 and 4 was poorer, and the rate of death from other diseases was higher than that in the non-elderly. These results suggest that we need to investigate the pre-existing comorbidities and check whether there are any other primary cancers preoperatively, decide the treatment plan carefully, perform the operation maintaining the curability rate if possible, and pay close attention to postoperative morbidities including delirium and respiratory complications.