de Leon Maurizio Ponz, Pezzi Annalisa, Benatti Piero, Manenti Antonio, Rossi Giuseppina, di Gregorio Carmela, Roncucci Luca
Dipartimento di Medicina Interna, Università di Modena e Reggio Emilia, Policlinico, Modena, Italy.
Int J Colorectal Dis. 2009 Jul;24(7):777-88. doi: 10.1007/s00384-009-0687-1. Epub 2009 Mar 11.
A general improvement of colorectal cancer prognosis has been observed. Reasons of this more favourable trend are diffusion of screening, advancements in molecular biology, new developments in chemotherapy and surgical techniques. Through the data of a colorectal cancer registry, we purposed to evaluate changes in surgical procedures for colorectal neoplasms and to analyse trends of perioperative mortality.
Patients with colorectal cancer were registered from 1984 to 2004. The main surgical procedures were recorded and classified. Perioperative mortality was defined as death of patients within 1 month since the operation.
Regression analysis showed an increase over time of right and left hemicolectomy. Both colectomy and endoscopic polypectomy showed significant rise over time. In contrast, abdominoperineal operations dropped during the study period. A similar decrease was observed for palliative surgery. Perioperative mortality declined from 7-11% to 3-6% of all operations; main factors associated with perioperative mortality were presence of comorbidities, increasing age and advanced stage.
The better prognosis of patients with colorectal cancer was associated with changes of surgical techniques, with a tendency to prefer large operations over limited resections. Perioperative mortality showed a gradual decrease and is at present in the order of 3% to 6% of all operations.
已观察到结直肠癌预后有总体改善。这种更有利趋势的原因包括筛查的普及、分子生物学的进展、化疗和手术技术的新发展。通过一个结直肠癌登记处的数据，我们旨在评估结直肠肿瘤手术程序的变化并分析围手术期死亡率趋势。
对1984年至2004年的结直肠癌患者进行登记。记录并分类主要手术程序。围手术期死亡率定义为术后1个月内患者死亡。
回归分析显示右半结肠切除术和左半结肠切除术随时间增加。结肠切除术和内镜下息肉切除术均随时间显著增加。相比之下，在研究期间腹会阴联合手术减少。姑息性手术也有类似下降。围手术期死亡率从所有手术的7% - 11%降至3% - 6%；与围手术期死亡率相关的主要因素是合并症的存在、年龄增长和疾病晚期。
结直肠癌患者预后较好与手术技术的改变有关，倾向于选择大手术而非有限切除。围手术期死亡率逐渐下降，目前约占所有手术的3%至6%。
