De Martino D, Joly A, Assenza M, Arnaud A, Sastre B, Sarles J C
Hôpital Sainte-Marguerite, Service de Chirurgie, Marseille.
Ann Chir. 1991;45(3):218-21.
The authors reviewed 122 rectal cancers observed over a period of 14 years in patients over the age of 75 years. Sixty-eight patients underwent extensive rectal resection, 17 were treated by local excision, and 28 only underwent a colostomy. Eight patients were excluded for surgery. The analysis of all of these groups showed that perioperative mortality was greater for large resections than for local resections, but with a lower recurrence rate and a higher survival at 3 years. Survival at 5 years after large resections was very close to the natural life expectancy for people of the same age. Moreover, survival was the quality of more comfortable than after local excision, and operative mortality was generally due to organ failure rather than to age itself. Radical surgery does not have to be systematically refused for very old patients, but he discussed in terms of the patients general status.
作者回顾了14年间75岁以上患者中观察到的122例直肠癌。68例患者接受了广泛的直肠切除术，17例接受了局部切除术，28例仅接受了结肠造口术。8例患者被排除在手术之外。对所有这些组的分析表明，大手术的围手术期死亡率高于局部切除术，但复发率较低，3年生存率较高。大手术后5年生存率非常接近同年龄人群的自然预期寿命。此外，大手术后的生存质量比局部切除术后更舒适，手术死亡率通常是由于器官衰竭而非年龄本身。对于高龄患者，不必系统性地拒绝根治性手术，但需根据患者的一般状况进行讨论。
