Savlovschi C, Serban D, Trotea T, Borcan R, Dumitrescu D
University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
Chirurgia (Bucur). 2013 Mar-Apr;108(2):177-9.
Surgical procedures with curative or palliative intention in colo-rectal neoplasm in subjects aged over 80 represent a surgical challenge due to the issue they raise: benefits versus increased morbidity. In Romania, according to demographic predictions, the population over the age of 65 will double in the next half century. This, correlated with the increased incidence of colo-rectal cancer in subjects pertaining to the 60- 69 age period and higher, determined us to identify the factors that can influence the occurrence of complications and post-surgery deaths in subjects over 80 years of age that were operated on for colo-rectal cancer.
This paper includes a retrospective analysis of patients aged over 80, diagnosed and treated for colo-rectal cancer in the 4th Surgery Department of the University Emergency Hospital in Bucharest, in the period 2000 - 2011, following the type of surgery, morbidity and postoperative mortality. Out of a total of 297 cases of patients operated on for colo-rectal cancer, 36 were identified with the age over 80, age average being 83 years (80-91).
Out of the total 36 patients aged over 80 years, 22 were subject to surgical procedures with curative intention (in 16 of these subjects a right hemicolectomy was performed and in 6 a left hemicolectomy), the remaining 14 subjects receiving palliative surgical treatment. The factors that negatively influenced post-surgery evolution were diabetes, pre-existing cardiac pathology, evolutionary stage of cancer and the urgency character. In the group with resections, we found a 27.2% (6 cases) morbidity rate and a 18.2% (4 cases) mortality rate. In patients undergoing palliative surgery, the morbidity rate was 28.5% (4 cases) with a mortality rate of 14.3% (2 cases).
Between the 2 groups of patients postoperative morbidity and mortality appeared to be equal. Most often, they were caused by pre-existing cardio-pulmonary pathology and by the urgency character of the surgery, that did not allow a proper rebalancing, and in a lesser extent by the type of surgery. During those 12 years, the percentage of patients aged over 80 years diagnosed annually with colorectal cancer remained constant. Despite advanced age and associated comorbidities, we consider the postoperative evolution to be satisfactory, although postoperative morbidity and mortality were higher than in the general population, according to the literature. Preoperative compensation of associated comorbidities, a surgical procedure performed by experienced teams, together with the ensuring of adequate intensive therapies are required to reduce postoperative risks.
对于80岁以上患有结直肠癌的患者，无论是进行根治性还是姑息性手术，都面临着手术挑战，因为这引发了一个问题：获益与发病率增加之间的权衡。在罗马尼亚，根据人口统计学预测，65岁以上的人口在接下来的半个世纪中将翻倍。这一情况，再加上60 - 69岁及以上人群中结直肠癌发病率的上升，促使我们去确定那些可能影响80岁以上接受结直肠癌手术患者并发症发生及术后死亡的因素。
本文对2000 - 2011年期间在布加勒斯特大学急诊医院第四外科被诊断并接受结直肠癌治疗的80岁以上患者进行了回顾性分析，分析内容包括手术类型、发病率及术后死亡率。在总共297例接受结直肠癌手术的患者中，确定有36例年龄超过80岁，平均年龄为83岁（80 - 91岁）。
在36例80岁以上的患者中，22例接受了根治性手术（其中16例行右半结肠切除术，6例行左半结肠切除术），其余14例接受了姑息性手术治疗。对术后病情发展产生负面影响的因素包括糖尿病、既往存在的心脏疾病、癌症的发展阶段以及手术的紧急程度。在接受切除术的患者组中，我们发现发病率为(27.2%)（6例），死亡率为(18.2%)（4例）。在接受姑息性手术的患者中，发病率为(28.5%)（4例），死亡率为(14.3%)（2例）。
两组患者术后的发病率和死亡率似乎相当。这些情况最常由既往存在的心肺疾病以及手术的紧急程度导致，紧急程度使得无法进行适当的调整，在较小程度上也由手术类型导致。在这12年期间，每年被诊断患有结直肠癌的80岁以上患者的比例保持不变。尽管患者年龄较大且伴有合并症，但根据文献，我们认为术后病情发展仍令人满意，尽管术后发病率和死亡率高于一般人群。需要对相关合并症进行术前调整，由经验丰富的团队进行手术，并确保提供充分的强化治疗以降低术后风险。
