高齢者食道癌の臨床的特徴および治療上の問題点と対策に関する検討

The Characteristics of Senior Esophageal Cancer Patients: Clinical Study of Problems and Solutions in Their Treatments

要旨　75歳以上の高齢者食道癌患者では，非高齢者に比較して循環器や脳血管疾患などの併存頻度が高く，また複数の併存疾患を有する割合が有意に高かった．治療方法では内視鏡治療の割合が高く，標準術式である右開胸開腹胸部食道切除術・頸部吻合など外科的根治術の割合が低下していた．食道癌根治手術は高齢者にとって大きな侵襲であるが，手術手技と周術期管理が向上し，手術適応と術式選択を慎重に判断することによって比較的安全に行われていた．非高齢者と比較してもその治療成績に有意差はないが，術後合併症として肺炎発症率が高く注意を要する．死亡原因としては原病死の割合に有意差は認めなかったが，他病死の割合が有意に高値を示した．高齢者食道癌患者の診療に当たっては，食道癌の諸因子に加え併存疾患や生理機能などの全身状態の因子を，慎重にチェックしたうえで患者本人の意欲や希望を尊重する必要がある．画一的な治療戦略は避け個別化治療を心掛けるべきであり，治療の安全性とQOLの向上を念頭に置くことが重要と考えられる．

　The senior esophageal patients over 75years of age were found to be complicated frequently with disorders of circulatory and neurovascular systems, and other diseases. Their treatments were conducted mainly by endoscopic maneuvres, and less frequently by esophagectomy using the right thoraco-abdominal approach and cervical anastomosis employed in younger patients. Those standard operations give great stress to the seniors, but they have tolerated them well, thanks to improvements of operative techniques and postoperative care. after adequate indication for operation and operative mode. Those invasive operations have produced quite good results even seniors, who develop pneumonia easily. The cause of death in these cases was significantly more related to underlying diseases in the seniors. In treating senior esophageal cancer patients, the existence of their underlying diseases as well as their physical capacity should be thoroughly estimated, and the standard treatment should not be automatically applied in every case. The safety of the treatment and improvement of QOL have priority when decisions regarding treatment our mode.