Tomimaru Y, Ide Y, Murata K
Department of Surgery, Suita Municipal Hospital, Suita, Japan.
Asian J Endosc Surg. 2011 Feb;4(1):1-6. doi: 10.1111/j.1758-5910.2010.00061.x. Epub 2010 Nov 5.
The aim of this study was to evaluate whether elderly patients with colorectal cancer benefit from laparoscopic colon surgery (LAC) in comparison to open colon surgery (OC).
Patients with colon cancer were divided into four groups; >75 years (CC(>75) ) [LAC(>75) (n=36), OC(>75) (n=15)] and ≤75 years [LAC(≤75) (n=90), OC(≤75) (n=26)]. Differences in postoperative short-term outcomes were analyzed among the age and procedure groups.
Intraoperative blood loss was significantly less in the LAC(>75) group (68 ± 168 ml) than in the OC(>75) group (118 ± 130 ml, P=0.040). The C-reactive protein of patients in the OC(>75) group (5.4 ± 2.2 mg/dl) tended to be less than that of the LAC(>75) group (6.1 ± 2.8 mg/dl, P=0.080) on postoperative day 1. The time to the first passage of flatus was significantly shorter in the LAC(>75) group (2.0 ± 0.7 days) than in the OC(>75) group (2.7 ± 0.8 days, P=0.003). Postoperative hospital stays were also shorter in the LAC(>75) group (14.2 ± 9.4 days) than in the OC(>75) group (18.0 ± 8.3 days, P=0.038). No mortality was registered in the LAC(>75) group, while one patient in the OC(>75) group died during the postoperative course. The rate of postoperative morbidity was similar between the LAC(>75) and OC(>75) groups [13.9% (5/36) versus 20.0% (3/15), P=0.679].
LAC provides some advantages over OC in patients with colon cancer aged >75 years as well as in those aged ≤75 years. LAC can be safely performed in very elderly patients with colon cancer.
本研究旨在评估老年结肠癌患者接受腹腔镜结肠手术（LAC）与开腹结肠手术（OC）相比是否有益。
结肠癌患者分为四组；年龄>75岁（CC(>75)）[LAC(>75)组（n = 36），OC(>75)组（n = 15）]和年龄≤75岁[LAC(≤75)组（n = 90），OC(≤75)组（n = 26）]。分析年龄组和手术组之间术后短期结果的差异。
LAC(>75)组术中失血量（68±168 ml）明显少于OC(>75)组（118±130 ml，P = 0.040）。术后第1天，OC(>75)组患者的C反应蛋白（5.4±2.2 mg/dl）倾向于低于LAC(>75)组（6.1±2.8 mg/dl，P = 0.080）。LAC(>75)组首次排气时间（2.0±0.7天）明显短于OC(>75)组（2.7±0.8天，P = 0.003）。LAC(>75)组术后住院时间（14.2±9.4天）也短于OC(>75)组（18.0±8.3天，P = 0.038）。LAC(>75)组无死亡病例，而OC(>75)组有1例患者在术后过程中死亡。LAC(>75)组和OC(>75)组术后发病率相似[13.9%（5/36）对20.0%（3/15），P = 0.679]。
LAC在年龄>75岁以及年龄≤75岁的结肠癌患者中比OC具有一些优势。LAC可以在高龄结肠癌患者中安全进行。
