Our Therapeutic Inventions in Geriatric Digestive Surgery -Metabolic Changes, Complications, and their Managements-

Harumasa Ohyanagi, Makoto Usami, Hiroshi Kasahara, Hideaki Nomura, Taichi Kanamaru, Koji Furuchi, Yonsun Ku, Michio Kato, Yoichi Saitoh

First Department of Surgery, Kobe University, School of Medicine

We investigated the operative results of digestive surgery for the aged from the viewpoint of their perioperative care. During the past 22 years (1969-1990, 3481 patients received operations for esophageal cancer, gastric cancer, hepatic, bilio-pancreatic malignancies, colon cancer, and gallstones, in our department.
The study was divided into two periods as 1969-1979 and 1980-1990, and all the patients were generally classified as the aged and the younger control by the age of 65, especially the patients with TER (thoratic esophageal resection) or PD (pancreatoduodenectomy) were classified by the age of 60, and those with TG (total gastrectomy) were by the age of 70. In each group, the incidence of pre- and post-operative complications, risk age (which is the critical age at which complications are likely to develop), serum parameters for operative stress, post-operative serum proteins, and immunological parameters were studied. Of the 3481 patients, 756 patients were more than 64 years old, accounting for 21.7% of all patients. A comparison of the first and second periods showed that the incidence of the post-operative complications and the post-operative death rate have decreased in the aged (55% vs 49%, 10% vs 3%, respectively). It has become to the elevation of the long-termed survival rate in the digestive surgery. This may be attributable to the improvements of operation methods and anesthesia, and to the remarkable progress in peri-operative managements including nutritional care which can minimize the hormonal and metabolic changes.

Key words
geriatric surgery, digestive surgery, pre- and post-operative complications, perioperative care, nutritional management

Reprint requests
Harumasa Ohyanagi First Department of Surgery, Kobe University School of Medicine
7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650 JAPAN

Accepted
November 20, 1991

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