95歳以上の超高齢大腸癌患者に対し腹腔鏡補助下の大腸癌根治切除術を行った2例

Two cases of laparoscopic-assisted radical resection for patients over 95 years with colorectal cancer

◆要旨：超高齢社会が進むにつれて超高齢者の大腸癌症例が増加している一方で，治療方針については慎重な検討が必要になる．症例1は96歳，女性．直腸S状部癌に対し腹腔鏡補助下高位前方切除術（D3）を施行した．症例2は98歳，男性．直腸S状部癌に対し腹腔鏡補助下Hartmann手術（D3）を施行した．2症例とも術前に栄養指標を用いて手術可能と判断し，術後は合併症を認めず退院した.

　95歳以上の超高齢者であっても術前の全身状態や栄養状態を適切に評価することで，安全に合併症なく腹腔鏡下手術を行うことができた．単施設だけでは集積が難しい超高齢者の症例経験は，今後超高齢者の手術適応について検討する際に有用であり，文献的考察を加え報告する．

　As the number of super elderly patients with colorectal cancer is increasing due to the aging of society, it is necessary to carefully consider the treatment options. The first patient is a 96-year-old woman in whom laparoscopy-assisted high anterior resection （D 3） was performed for rectosigmoid cancer. The second patient is a 98-year-old man who underwent laparoscopy-assisted Hartmann's surgery （D 3） for rectosigmoid cancer. The general condition of both patients was evaluated using nutritional indicators before surgery, and the surgery was judged to be possible. After surgery, both patients were discharged with no specific perioperative complications and are currently alive without any recurrence.

　Laparoscopic surgery can be safely performed even in super-elderly people aged 95 and over by appropriately evaluating their general condition and nutritional status before surgery. Therapeutic effects can also be obtained without complications.

　Accumulation of surgical cases involving the super elderly, which is difficult to acquire in a single facility, will be useful when considering surgical indications in these patients in the future. Here, we report our experience of super elderly patients who underwent surgery and review the literature.