Lancet. 2000 Sep 16;356(9234):968-74.
The effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives, with an improved postoperative life expectancy, or at least one that is not diminished by the surgery. Because colorectal cancer is a major cause of morbidity and mortality in elderly people, we have examined how the outcomes of surgery in elderly patients differ from those in younger patients.
We did a systematic review of published and aggregate data provided by investigators. Studies were identified by computerised and manual searches of published and unpublished reports, scanning references, and contacting investigators. Within each study, outcomes for patients aged 65-74 years, 75-84 years, and 85+ years were expressed in relation to those aged less than 65 years.
From 28 independent studies, and a total of 34,194 patients, we found that elderly patients had an increased frequency of comorbid conditions, were more likely to present with later-stage disease and undergo emergency surgery, and less likely to have curative surgery than younger patients. The incidence of postoperative morbidity and mortality increased progressively with advancing age. Overall survival was reduced in elderly patients, but for cancer specific survival age-related differences were much less striking.
The relation between age and outcomes from colorectal cancer surgery is complex and may be confounded by differences in stage at presentation, tumour site, pre-existing comorbidities, and type of treatment received. However, selected elderly patients benefit from surgery since a large proportion survive for 2 or more years, irrespective of their age.
结直肠癌手术的有效性取决于手术的安全性，这能使大多数患者恢复正常生活，提高术后预期寿命，或者至少不会因手术而缩短预期寿命。由于结直肠癌是老年人发病和死亡的主要原因，我们研究了老年患者手术结果与年轻患者的差异。
我们对研究者提供的已发表和汇总数据进行了系统评价。通过对已发表和未发表报告的计算机检索和人工检索、扫描参考文献以及联系研究者来识别研究。在每项研究中，将65 - 74岁、75 - 84岁和85岁及以上患者的结果与年龄小于65岁患者的结果进行比较。
从28项独立研究和总共34194例患者中，我们发现老年患者合并症的发生率更高，更有可能出现晚期疾病并接受急诊手术，与年轻患者相比，接受根治性手术的可能性更小。术后发病率和死亡率随着年龄的增长而逐渐增加。老年患者的总生存率降低，但癌症特异性生存率的年龄相关差异不太明显。
年龄与结直肠癌手术结果之间的关系很复杂，可能会因就诊时的分期、肿瘤部位、既往合并症以及接受的治疗类型的差异而混淆。然而，部分老年患者从手术中获益，因为很大一部分患者无论年龄大小都能存活2年或更长时间。
