Department of Surgery Michael E DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA.
J Surg Res. 2011 Apr;166(2):182-8. doi: 10.1016/j.jss.2010.05.053. Epub 2010 Dec 10.
Minimally invasive surgery (MIS) for colorectal resection has been shown to improve short-term outcomes compared with open surgery in patients with colorectal cancer. Currently, there is a paucity of data demonstrating similar efficacy between MIS and open colorectal resection in the elderly population. We hypothesized that minimally invasive surgery provides improved short-term outcomes in elderly patients with colorectal cancer.
A review of 242 consecutive elderly (≥ 65 y of age) patients who underwent either open or MIS colorectal resection for adenocarcinoma at one institution was conducted. Short-term and oncologic outcomes were analyzed. Continuous variables were analyzed by the Mann-Whitney U test. Categorical variables were compared by χ(2) tests. Survival was compared by the Kaplan-Meier method using the log rank test for comparison.
Of the 242 elderly patients with colorectal cancer (median American Society of Anesthesiology score (ASA) scores of 3), 80% (n = 195) of patients underwent open and 20% (n = 47) had MIS colorectal cancer resections. Patients undergoing MIS had a faster return of bowel function, decreased days to nasogastric tube removal, decreased days to flatus and bowel movement, and quicker advancement to clear liquid and regular diets. The overall length of hospital stay in the MIS group was decreased by 40% as well as a trend towards a 50% decrease in SICU stay. Additionally, there was 66% decrease in cardiac complications in the MIS group. When evaluating for oncologic adequacy as measured by number of lymph nodes and surgical resection margins, MIS surgery offered equivalent results as open resection. Furthermore, there was no significant difference in overall survival for MIS versus open colorectal surgery.
Minimally invasive colorectal cancer resection leads to improved short-term outcomes as demonstrated by decreased length of hospital stay and faster return of bowel function. Additionally, there appears to be no difference in oncologic outcomes in the elderly. On the basis of our data, age alone should not be a contra-indication to laparoscopic colorectal cancer resection.
微创外科（MIS）在结直肠癌患者中与开放性手术相比，已被证实可改善短期结局。目前，关于MIS 和开放性结直肠切除术在老年人群中的相似疗效的数据较少。我们假设微创外科为老年结直肠癌患者提供了更好的短期结局。
对一家机构的 242 例连续老年（≥65 岁）接受开放性或 MIS 结直肠切除术的腺癌患者进行了回顾性分析。分析了短期和肿瘤学结局。连续变量采用 Mann-Whitney U 检验进行分析。分类变量采用卡方检验进行比较。采用 Kaplan-Meier 法比较生存情况，采用对数秩检验进行比较。
在 242 例老年结直肠癌患者（中位美国麻醉医师协会评分（ASA）评分 3 分）中，80%（n=195）的患者行开放性结直肠癌切除术，20%（n=47）的患者行 MIS 结直肠癌切除术。MIS 组患者术后肠道功能恢复更快，胃管拔除时间、肛门排气排便时间、肠内营养开始时间及普通饮食开始时间均明显缩短。MIS 组患者的总住院时间缩短了 40%，重症监护病房住院时间缩短了 50%。此外，MIS 组的心脏并发症减少了 66%。从淋巴结清扫数目和手术切缘评估肿瘤学充分性，MIS 手术与开放性切除术结果相当。此外，MIS 与开放性结直肠手术的总生存率无显著差异。
MIS 结直肠癌切除术可改善短期结局，表现为住院时间缩短，肠道功能恢复更快。此外，在老年患者中，肿瘤学结局似乎没有差异。基于我们的数据，年龄本身不应成为腹腔镜结直肠癌切除术的禁忌症。
