Department of Hepatobiliary Surgery, Basingstoke and North Hampshire Foundation Trust, Basingstoke, Hampshire, UK.
Colorectal Dis. 2012 Oct;14(10):1210-6. doi: 10.1111/j.1463-1318.2012.02946.x.
Despite the incidence of colorectal cancer increasing with age the proportion of patients undergoing surgery for colorectal liver metastases decreases dramatically in the elderly. Is this referral or selection bias justified?
A prospective database of resection for colorectal liver metastases at a single centre was retrospectively analysed to compare the outcome in patients aged ≥75 years (group E) with those aged <75 years (group Y). Data were analysed using the Kaplan-Meier method with Cox regression modelling.
Of 1443 resections, 151 (10.5%) in group E were compared with 1292 (89.5%) in group Y. The two groups were matched apart from higher American Society of Anesthesiology scores (P=0.001) and less use of chemotherapy (P=0.01) in the elderly. Perioperative morbidity and 90-day mortality were higher in the elderly compared with the younger group (32.5%vs 21.2%, P=0.02, and 7.3%vs 1.3%, P=0.001). In the last 5 years, mortality in the elderly improved and was no longer significantly different from that of the younger patients [n=2/76 (2.6%) vs n=9/559 (1.6%); P=0.063]. The 5-year survival was similar in groups E and Y for cancer-specific (41.4%vs 41.6%, P=0.917), overall (37.0%vs 38.2%) and median (44.1 months vs 43.6 months, P=0.697) survival respectively.
In the elderly liver resection for metastatic disease can be performed with acceptable mortality and morbidity with as good a prospect of survival as for younger patients.
尽管结直肠癌的发病率随年龄增长而增加，但在老年人中，接受结直肠肝转移手术的患者比例却显著下降。这种转诊或选择偏倚是否合理？
回顾性分析单中心行结直肠肝转移灶切除术的前瞻性数据库，比较年龄≥75 岁（E 组）和<75 岁（Y 组）患者的结果。采用 Kaplan-Meier 方法和 Cox 回归模型进行数据分析。
在 1443 例切除术中，E 组中有 151 例（10.5%）与 Y 组中的 1292 例（89.5%）进行了比较。两组除美国麻醉医师协会评分较高（P=0.001）和化疗使用率较低（P=0.01）外，其他方面匹配。与年轻组相比，老年组围手术期发病率和 90 天死亡率更高（32.5%对 21.2%，P=0.02；7.3%对 1.3%，P=0.001）。在过去 5 年中，老年患者的死亡率有所改善，不再显著高于年轻患者[76 例中 2 例（2.6%）与 559 例中 9 例（1.6%）；P=0.063]。E 组和 Y 组的癌症特异性生存率（41.4%对 41.6%，P=0.917）、总生存率（37.0%对 38.2%）和中位生存率（44.1 个月对 43.6 个月，P=0.697）相似。
对于老年患者，转移性疾病的肝切除术可以在可接受的死亡率和发病率下进行，其生存前景与年轻患者一样好。
