Tsar'kov P V, Nikoda V V, Stamov V I, Markar'ian D R, Tulina I A
Khirurgiia (Mosk). 2012(2):4-13.
Publications of the last few years indicate a steady rise of colorectal cancer in the world. Colorectal cancer is on the second place in the structure of oncological mortality in developed countries, including Russia. The majority of colorectal cancer deaths (up to 50%) occur in elderly. The octogenarians are more likely to have comorbidities and age-specific deteriorating organ function, which could make their tolerance of surgery. To determine the short- and long-term outcomes of the multidisciplinary approach in elective colorectal surgery in patients ≥75 years of age. A review 70 octogerians who underwent colorectal cancer surgery between April 2006 and November 2010 was performed from prospectively collected database. The median age was 79 (75-95) years. Every patient was examined by multidisciplinary team before surgery. Conservative therapy was prescribed or corrected if any organ failure detected. After the period of treatment decision on their suitability for surgery was made. Comorbidities were quantified using the weighted Charlson Comorbidity Index and ASA classification. CR-POSSUM scores and the predicted mortality rates were calculated. Outcome measures were morbidity rates and 30-day mortality rates. The mean index of comorbidity was 7.3 (6-11) and 81% of patients were classified ASA III and above. The mean predicted mortality rate based on CR-POSSUM scoring model was 14.8%. All patients with comorbidities were treated conservatively during mean period of 12.2 days, nine patients (13%) required implantations of pacemakers to control heart rate in perioperative period. In 64 (91%) cases surgical resection of the colon or rectum with primary anastomosis were performed, in 6 (9%) - abdominoperineal resection of the rectum and in two cases - Hartmann's operation. Postoperative complications were noticed in 40 (57%) cases. Postoperative mortality rate (death within 30 days of surgery) was 5.7%, the 2- and 3-year overall survival rate according to Kaplan and Meier was 78.3±5.6% and 74.9±6.3% respectively. Using the multidisciplinary approach in the management of elderly allows reaching the acceptable mortality level (5.7% in comparison with predicted 14.8%) and high 2- and 3-year survival rates. This means that chronological age alone should not be contraindication to the elective curative surgery of colorectal cancer in elderly if overall assessment of the perioperative risk is possible. The study aimed to asses the intermediate and long-term results of the multidisciplinathe colorectal cancer in elderly patients. 70 patients, aged 75-95 years, were prospectively chosen to participate the study. The comorbidity Charlson index and ASA scale were used to measure the perioperative risks. The CR-POSSUM scale was used for postoperative lethality rating. The use of the above listed scales and measurements in combination with multidisciplinary conservative preaparation of patients before the operation allowed to achieve the satisfactory lethality rate of 5.7% and higher long-term survival rates after the colorectal surgery.
过去几年的出版物表明，全球结直肠癌的发病率呈稳步上升趋势。在包括俄罗斯在内的发达国家，结直肠癌在肿瘤死亡率结构中位居第二。大多数结直肠癌死亡病例（高达50%）发生在老年人中。八旬老人更容易患有合并症，且器官功能会因年龄增长而恶化，这可能影响他们对手术的耐受性。为了确定多学科方法在75岁及以上患者择期结直肠癌手术中的短期和长期效果。对2006年4月至2010年11月期间接受结直肠癌手术的70名八旬老人进行了回顾性研究，这些数据来自前瞻性收集的数据库。中位年龄为79岁（75 - 95岁）。每位患者在手术前均由多学科团队进行检查。如果检测到任何器官功能衰竭，则进行保守治疗或调整治疗方案。在经过治疗期后，做出关于其是否适合手术的决定。使用加权查尔森合并症指数和美国麻醉医师协会（ASA）分类对合并症进行量化。计算CR - POSSUM评分和预测死亡率。观察指标为发病率和30天死亡率。合并症平均指数为7.3（6 - 11），81%的患者被分类为ASA III级及以上。基于CR - POSSUM评分模型的平均预测死亡率为14.8%。所有患有合并症的患者平均接受了12.2天的保守治疗，9名患者（13%）在围手术期需要植入起搏器来控制心率。64例（91%）患者进行了结肠或直肠手术切除并一期吻合，6例（9%）进行了直肠腹会阴联合切除术，2例进行了哈特曼手术。40例（57%）患者出现术后并发症。术后死亡率（术后30天内死亡）为5.7%，根据 Kaplan - Meier法计算的2年和3年总生存率分别为78.3±5.6%和74.9±6.3%。在老年患者的管理中采用多学科方法可使死亡率达到可接受水平（与预测的14.8%相比为5.7%），并获得较高的2年和3年生存率。这意味着，如果能够对围手术期风险进行全面评估，仅年龄不应成为老年患者择期结直肠癌根治性手术的禁忌证。该研究旨在评估多学科方法治疗老年患者结直肠癌的中期和长期结果。前瞻性选择了70例年龄在75 - 95岁之间的患者参与研究。使用合并症查尔森指数和ASA量表来衡量围手术期风险。使用CR - POSSUM量表进行术后致死率评级。在手术前将上述量表和测量方法与多学科保守准备相结合，使得结直肠癌手术后的致死率达到了令人满意的5.7%，并获得了较高的长期生存率。
