16. 75歳以上の高齢者肺癌手術と周術期管理

Perioperative Management for Lung Cancer in the Elderly Over 75 Years Old

わが国は世界でもっとも高齢化がすすんでいる国であり，高齢者が21％以上を占める超高齢社会となっている1）．そのため，今後もますます高齢者に対する肺癌手術は増加することが予想される．

In Japan, where the population is aging, the number of elderly lung cancer cases is expected to increase. Therefore, we retrospectively compared and examined about elderly lung cancer.

Method：There were 1,283 patients undergoing surgery for lung cancer between 2009 and 2018 at our institution. We classified them into 75～85 years old, 85 years old or older, and younger than 75 years, and examined the patient background, surgical procedure, and perioperative complications.

Result：96.2％ of 75～85 years group and 100％ of 85 years old or older group had some history. There was a significant difference between the ages of 85 years old or older in PS 1 and above. There was a significant difference in limited resection between the 2 elderly groups compared to younger than 75 years group. The perioperative complication rates were 75～85 years old group （23.2％）, 85 years old or older （30.9％）, and younger than 75 years group （23.2％）, with no significant difference. There were significant differences in postoperative delirium and chronic respiratory failure in 75～85 years group and 85 years old or older compared with younger than 75 years group. We performed a multivariate analysis of risk factors for complications. Males, PS 1 or higher, approach ［thoracotomy, video-assisted thoracic surgery （VATS）］, and limited resection were considered to be independent factors. The 5-year survival rate was 70.9％ in 75～85 years group, 39.3％ in 85 years old or older group, and 81.0％ in younger than 75 years group, and was significantly lower in 85 years old or older group.

Conclusion：Elderly patients need to be aware of postoperative delirium and chronic respiratory failure. It is possible that the complication rate can be reduced by performing a thorough evaluation of operative resistance and selecting an appropriate surgical procedure in the elderly.