Gunka I, Dostalík J, Martínek L, Guńková P, Mazur M, Vávra P
Chirurgická Klinika, Fakultní Nemocnice Ostrava.
Rozhl Chir. 2010 Oct;89(10):628-33.
The aim of this study was to evaluate the results of laparoscopically-assisted (LAC) and open (OC) colorectal surgery in elderly patients (a 75 years) and to compare them to a cohort of younger patients (<75 years) undergoing similar surgical procedures.
Patients who underwent elective laparoscopically-assisted or open colorectal surgery in the period between January 2001 and December 2009 were included in the analysis. The primary end point was the incidence of short-term postoperative morbidity and mortality, long-term overall and colorectal cancer specific survival which were analyzed in relation to the age and operative technique.
During the study period, 557 elective laparoscopic and 404 elective open colorectal operations were performed. 190 patients (20 %) were older than 75 years, 99 of which underwent laparoscopic and 91 open surgery. In geriatric patients, the open approach was associated with increase of postoperative morbidity, statistically nonsignificant (LAC > or = 75 years 30% vs. OC < 75 years 40%, p = 0,151). In the laparoscopic procedures, the morbidity rate did not differ in both age groups (LAC > or = 75 years 30% vs. LAC < 75 years 28%, p = 0,702). Conversely open procedures in elderly patients were associated with a significant increase of postoperative complications compared to younger patients (OC > or = 75 years 40% vs. OC < 75 years 29%, p= 0,033). There was no difference in postoperative mortality rate between laparoscopic and open approach in geriatric patients (LAC > or = 75 years 5% vs. OC > or = 75 years 3%, p=0,548). Mortality rate did not differ in both age groups operated laparoscopically (LAC > or = 75 years 5% vs. LAC < 75 years 3%, p = 0,322) even by open approach (OC > or = 75 years 3% vs. OC <75 years 2%, p = 0,433). Although five year overall survival was significantly lower in the older age group (LAC > or = 75 years 43 +/- 8% vs. LAC < 75 years 58 +/- 4 %, p = 0,049; OC - 75 years 35 +/- 7% vs. OC < 75 years 56 +/- 4%, p = 0,006), five year colorectal cancer specific survival was not different between both age groups (LAC > or = 75 years 76 +/- 9% vs. LAC < 75 years 75 +/- 4%, p = 0,693; OC > or = 75 years 67 +/- 7% vs. OC < 75 years 69 +/- 4%, p = 0,824). In the elderly patients surgical technique did not influenced overall five year survival (LAC > or = 75 years 43 +/- 8% vs. OC > or = 75 years 35 +/- 7%, p = 0,428), even five year colorectal cancer specific survival (LAC . or = 75 years 76 +/- 9% vs. OC a 75 years 69 +/- 7%, p = 0,393).
Laparoscopically-assisted colorectal surgery should be particularly considered in geriatric patients, for the reason of lower incidence of postoperative complications. Oncological safety of miniinvasive approach in the treatment of colorectal cancer is valid also for the specific group of elderly patients.
本研究旨在评估老年患者（年龄≥75岁）行腹腔镜辅助（LAC）和开放（OC）结直肠手术的结果，并与接受类似手术的年轻患者队列（年龄<75岁）进行比较。
纳入2001年1月至2009年12月期间接受择期腹腔镜辅助或开放结直肠手术的患者进行分析。主要终点是术后短期发病率和死亡率、长期总生存率和结直肠癌特异性生存率，并根据年龄和手术技术进行分析。
在研究期间，共进行了557例择期腹腔镜和404例择期开放结直肠手术。190例患者（20%）年龄大于75岁，其中99例行腹腔镜手术，91例行开放手术。在老年患者中，开放手术方式与术后发病率增加相关，但无统计学意义（LAC≥75岁组为30%，OC<75岁组为4%，p=0.151）。在腹腔镜手术中，两个年龄组的发病率无差异（LAC≥75岁组为%，LAC<75岁组为28%，p=0.702）。相反，与年轻患者相比，老年患者的开放手术术后并发症显著增加（OC≥75岁组为40%，OC<75岁组为29%，p=0.033）。老年患者腹腔镜和开放手术方式的术后死亡率无差异（LAC≥75岁组为5%，OC≥75岁组为3%，p=0.548）。两个年龄组腹腔镜手术的死亡率也无差异（LAC≥75岁组为5%，LAC<75岁组为3%，p=0.322），开放手术方式下也是如此（OC≥75岁组为3%，OC<75岁组为2%，p=0.433）。尽管老年年龄组的五年总生存率显著较低（LAC≥75岁组为43±8%，LAC<75岁组为58±4%，p=0.049；OC≥75岁组为35±7%，OC<75岁组为56±4%，p=0.006），但两个年龄组的五年结直肠癌特异性生存率无差异（LAC≥75岁组为76±9%，LAC<75岁组为75±4%，p=0.693；OC≥75岁组为67±7%，OC<7岁组为69±4%，p=0.824）。在老年患者中，手术技术对总体五年生存率没有影响（LAC≥75岁组为43±8%，OC≥75岁组为35±7%，p=0.428），对五年结直肠癌特异性生存率也没有影响（LAC≥75岁组为76±%，OC≥75岁组为69±7%，p=0.393）。
由于术后并发症发生率较低，老年患者应特别考虑行腹腔镜辅助结直肠手术。微创方法治疗结直肠癌对老年患者这一特定群体同样具有肿瘤学安全性。
