Eindhoven Cancer Registry, Comprehensive Cancer Center South (CCCS), Eindhoven, The Netherlands.
Ann Surg Oncol. 2013 Feb;20(2):371-80. doi: 10.1245/s10434-012-2663-1. Epub 2012 Sep 18.
Studies on the impact of comorbidity and age on postoperative outcome after gastrointestinal tumor resection are scarce. In this study we investigated the impact of comorbidity and age on 30-, 60-, and 90-day mortality after resection of esophageal, gastric, periampullary, colon, and rectal cancer.
The study included 8,583 patients recorded in the population-based Netherlands Cancer Registry, regions Eindhoven (Eindhoven Cancer Registry) and Mid and South Limburg, who underwent resection for cancer stage I-III. Patients were diagnosed between 2005 and 2010. Age was categorized as <65, 65-74, and ≥75 years.
Comorbidity was present in more than two-thirds (n = 5,910) of patients. The 30-day mortality rates ranged from 0.5 % for rectal cancer patients <65 years to 12.8 % for gastric cancer patients ≥75 years. Patients with comorbidity who underwent esophageal tumor resection had the highest mortality rates, ranging from 8.4 % for 30-day to 12.0 % for 90-day mortality, while rectal cancer patients had the lowest rates, that is, 4.3-6.4 %, respectively. In multivariable analyses, cardiac disease (odds ratio [OR] = 1.74, 95 % confidence interval [95 % CI] = 1.32-2.30), vascular disease (OR = 1.41, 95 % CI = 1.02-1.95) and previous malignancies (OR = 1.38, 95 % CI = 1.02-1.86) in colon cancer, and cardiac disease (OR = 1.81, 95 % CI = 1.10-2.98) and vascular disease (OR = 1.95, 95 % CI = 1.11-3.42) in rectal cancer were associated with the highest 30-day mortality.
Postoperative mortality extends beyond 30 days. Comorbidity and older age are associated with early postoperative mortality after gastrointestinal cancer resection. Underlying comorbidity should be identified preoperatively with attention to patients' specific needs to optimally attenuate risk prior to surgery. A less aggressive treatment approach may well be considered in these groups.
关于合并症和年龄对胃肠道肿瘤切除术后术后结果的影响的研究很少。本研究调查了合并症和年龄对食管、胃、胰周、结肠和直肠肿瘤切除术后 30、60 和 90 天死亡率的影响。
本研究纳入了在人群基础荷兰癌症登记处(Eindhoven 癌症登记处)和米德尔堡和南林堡地区记录的 8583 例接受癌症 I-III 期切除术的患者。患者诊断于 2005 年至 2010 年之间。年龄分为<65、65-74 和≥75 岁。
超过三分之二(n=5910)的患者存在合并症。30 天死亡率范围从直肠肿瘤患者<65 岁的 0.5%到胃肿瘤患者≥75 岁的 12.8%。接受食管肿瘤切除术的合并症患者死亡率最高，30 天死亡率为 8.4%，90 天死亡率为 12.0%，而直肠肿瘤患者死亡率最低，分别为 4.3%-6.4%。在多变量分析中，心脏病(优势比[OR]=1.74，95%置信区间[95%CI]=1.32-2.30)、血管疾病(OR=1.41，95%CI=1.02-1.95)和先前的恶性肿瘤(OR=1.38，95%CI=1.02-1.86)与结肠肿瘤的 30 天死亡率最高相关，而心脏病(OR=1.81，95%CI=1.10-2.98)和血管疾病(OR=1.95，95%CI=1.11-3.42)与直肠肿瘤的 30 天死亡率最高相关。
术后死亡率超过 30 天。合并症和年龄较大与胃肠道癌症切除术后早期术后死亡率相关。应在术前确定合并症，并注意患者的特殊需求，以在手术前最佳降低风险。在这些群体中，可能需要考虑采用不那么激进的治疗方法。
