Falch Claudius, Kratt Thomas, Beckert Stefan, Kirschniak Andreas, Zieker Derek, Königsrainer Ingmar, Löb Stefan, Hartmann Joerg T, Königsrainer Alfred, Brücher Bjorn L D M
Department of Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen, Germany.
Onkologie. 2009 Feb;32(1-2):10-6. doi: 10.1159/000184580. Epub 2009 Jan 20.
The incidence of colorectal carcinoma increases rapidly in aged patients. We investigated retrospectively the differences in treatment relative to the patients' age.
A total of 394 patients with colorectal carcinoma (group I: > or =80 years, n = 197; group II: 60-79 years, n = 197) were analyzed in an average period of 4 years in relation to surgery, comorbidities, postoperative morbidity, mortality, survival and recurrence.
Patients > or =80 years had a significantly higher rate of comorbid conditions (p = 0.04; cardiovascular, p = 0.01; diabetes mellitus, p < 0.05) and more carcinomas in the sigmoid/rectum (72% vs. 67%; p < 0.05). Tumor stage, R0 resection rate, and overall complication rate were not influenced by age. The 30-day mortality rate was significantly higher in group I (12% vs. 3%; p = 0.02). Emergency surgical procedures were required significantly more often in group I (14%) than in group II (5%; p = 0.003). The 5-year survival rate among patients in group I was 30.1% compared to 50.5% among patients in group II (p < 0.0001).
Elderly patients have a higher rate of comorbidity and a higher postoperative 30-day mortality rate. Tumor stage, R0 resection rate, and overall postoperative complication rate do not appear to be influenced by age. The higher rate of emergency operations on patients > or =80 years is associated with the higher 30-day mortality. Even in patients aged > or =80 years, attention should focus on the long-term oncological results, after appropriate assessment of the preoperative risk.
老年患者中结直肠癌的发病率迅速上升。我们回顾性研究了治疗方法相对于患者年龄的差异。
总共394例结直肠癌患者（I组：年龄≥80岁，n = 197；II组：60 - 79岁，n = 197）在平均4年的时间里接受了关于手术、合并症、术后发病率、死亡率、生存率和复发情况的分析。
年龄≥80岁的患者合并症发生率显著更高（p = 0.04；心血管疾病，p = 0.01；糖尿病，p < 0.05），且乙状结肠/直肠部位的癌症更多（72%对67%；p < 0.05）。肿瘤分期、R0切除率和总体并发症发生率不受年龄影响。I组的30天死亡率显著更高（12%对3%；p = 0.02）。I组（14%）比II组（5%）更频繁地需要进行急诊手术（p = 0.003）。I组患者的5年生存率为30.1%，而II组患者为50.5%（p < 0.0001）。
老年患者合并症发生率更高，术后第30天死亡率更高。肿瘤分期、R0切除率和总体术后并发症发生率似乎不受年龄影响。年龄≥80岁患者急诊手术率较高与30天死亡率较高相关。即使对于年龄≥80岁的患者，在适当评估术前风险后，也应关注长期肿瘤学结果。
