超高齢者（85歳以上）における腹腔鏡下大腸切除の検討

Outcomes of laparoscopic surgery for colorectal cancer in oldest-old patients（≥85 years old）

◆要旨：【目的】85歳以上の超高齢者に対する腹腔鏡下大腸切除の安全性，有用性について検討した．【対象】大腸癌に対して切除を施行した85歳以上の超高齢者53例について腹腔鏡下手術（LAC）群14例と開腹手術（OC）群39例に分けて比較検討した．【結果】術前併存症（LAC/OC）は78.5％/82％と差は認めなかった．手術時間はLAC群で長く（232分/147分）,出血量は少なかった（71ml/199ml）．術後合併症（LAC/OC）は3例（21％）/23例（59％）であった．排便，排ガス確認日，飲水開始日，食事開始日は有意差をもってLAC群が早く,術後在院日数は，有意差をもってLAC群で短かった（11.5日/15.6日）．【結論】85歳以上の超高齢者に対する腹腔鏡下大腸切除は安全に施行しうる．

［Background］The efficacy and safety of laparoscopic colorectal surgery in oldest-old patients（≥85 years） is unclear. This study aimed to evaluate the short-term outcomes of laparoscopic colorectal cancer surgery compared with open surgery in the oldest-old.［Methods］Fourteen patients aged 85 years and older with colorectal cancer who underwent laparoscopic surgery（LAC group） were compared with 39 patients aged 85 years and older who underwent open surgery（OC group）.［Results］There were no significant differences in the comorbidity rate and American Society of Anesthesiologists（ASA） grade between the groups. The mean operating time was significantly longer（232 vs. 147 min, P<0.001）, but mean estimated blood loss was significantly less（71 vs. 199 ml, P＝0.0176） in the LAC group than in the OC group. The rate of postoperative complications（21.4 vs. 58.9％） tended to be lower in the LAC group than in the OC group. The mean time to flatus and time to diet and length of postoperative hospital stay（11.5 vs. 15.6 days） were significantly shorter in the LAC group than in the OC group. ［Conclusions］Laparoscopic surgery for colorectal cancer in oldest-old patients can be safely performed with better short-term outcomes compared with open surgery.