Department of Surgery, Río Hortega University Hospital, Valladolid, Spain.
Colorectal Dis. 2012 Jan;14(1):44-7. doi: 10.1111/j.1463-1318.2011.02596.x.
The aim of the study was to analyze the short-term and long-term outcomes of nonagenarians treated for colorectal cancer.
A retrospective analysis was performed of 74 patients, ≥ 90 years of age, diagnosed with colorectal cancer during the period 1986-2009. Comorbidity, American Society of Anesthesiology (ASA) grade, symptoms, diagnosis, treatment, mortality, morbidity and survival were analyzed.
Of the 74 patients, 48 (65%) were women. Twenty-two patients were classified as ASA grade I-II, 26 as ASA grade III and 26 as ASA grade IV-V. Thirty-one (42%) had intestinal obstruction at the time of diagnosis. Twenty-two (30%) patients were diagnosed during the period 1986-2000 and 52 (70%) were diagnosed between 2001 and 2009. Forty-four (59%) patients underwent surgery, of whom 19 (49%) were treated as an emergency. Eleven (25%) patients died postoperatively, with mortality rates of 12% (3/25) for elective surgery and 42% (8/19) for emergency surgery. Surgical mortality for ASA grade I and grade II patients was 5% (1/20) and their 5-year survival rate (postoperative mortality excluded) was 44%, whereas 5-year survival for ASA grade III patients who underwent surgery was 12.5% and surgical mortality was 25% (4/16). There were no survivors beyond 36 months among patients who did not receive surgery.
Our results indicate that elective and emergency colorectal surgery can be performed with acceptable rates of mortality and morbidity on nonagenarian patients in good general condition with low perioperative risk. The 5-year survival rate was related to ASA grade and to the use of surgery.
本研究旨在分析 90 岁以上高龄结直肠癌患者的短期和长期治疗效果。
回顾性分析了 1986 年至 2009 年期间诊断为结直肠癌的 74 例年龄≥90 岁的患者。分析了合并症、美国麻醉医师协会（ASA）分级、症状、诊断、治疗、死亡率、发病率和生存率。
74 例患者中，女性 48 例（65%）。22 例患者 ASA 分级为Ⅰ-Ⅱ级，26 例为 ASA 分级为Ⅲ级，26 例为 ASA 分级为Ⅳ-Ⅴ级。31 例（42%）在诊断时存在肠梗阻。22 例（30%）患者诊断于 1986-2000 年期间，52 例（70%）诊断于 2001-2009 年期间。44 例（59%）患者接受了手术治疗，其中 19 例（49%）为急诊手术。11 例（25%）患者术后死亡，择期手术的死亡率为 12%（3/25），急诊手术的死亡率为 42%（8/19）。ASA 分级Ⅰ和Ⅱ级患者的手术死亡率为 5%（1/20），术后 5 年生存率（排除术后死亡）为 44%，而接受手术治疗的 ASA 分级Ⅲ级患者的 5 年生存率为 12.5%，手术死亡率为 25%（4/16）。未接受手术的患者均未存活超过 36 个月。
对于一般状况良好、围手术期风险较低的 90 岁以上高龄患者，选择性和急诊结直肠手术可获得可接受的死亡率和发病率。5 年生存率与 ASA 分级和手术使用有关。
