Sheikh Adnan Ahmed, Joel A S, Johnson M A, Vimalachandran D
Countess of Chester Health Park, Chester, UK.
S Afr J Surg. 2013 May 3;51(2):68-72. doi: 10.7196/sajs.1535.
Octogenarians constitute a rapidly growing segment of patients undergoing colorectal cancer resection, but their outcomes remain understudied and under-reported. Our aims were to analyse outcomes of octogenarian patients undergoing curative colorectal resections compared with a similar cohort 2 decades younger.
Data from a prospectively collected database of consecutive patients undergoing colorectal resection between 2004 and 2006 were analysed. Primary endpoints were 30-day mortality and morbidity. The secondary endpoint was long-term survival.
Eighty-one consecutive patients aged >80 years and 61 patients aged 60 - 70 years undergoing elective and emergency resections were identified. In the octogenarian group, 75.3% of resections were elective compared with 78.0% in the younger cohort (p=0.9), with pelvic procedures accounting for 34.6% and 44.3%, respectively (p=0.34). The elderly had a significantly higher median CR-Possum (performance status) score than the younger cohort (18.0 v. 14.0; p=0.001). Permanent stoma rates were similar (22% for octogenarians v. 27% for younger patients; p=0.8), as was pathological stage (p=0.24). There was 1 death within 30 days after resection in each group. Median survival in the octogenarian cohort was 73 months compared with 74 months in the younger cohort, and 5-year survival rates were 53.1% and 66.0%, respectively (p=0.2, Mantel-Cox). CR-Possum score did not affect overall survival (p=0.711, Mantel-Cox), but a higher score correlated with more postoperative complications in both groups.
Octogenarians have poor performance status, but can undergo resection with acceptable mortality and morbidity. Overall survival in the two age groups studied was similar, with poor performance status being associated with higher postoperative complications but no long-term difference in survival.
八十多岁的老人是接受结直肠癌切除术的患者中数量迅速增长的一部分，但他们的治疗结果仍未得到充分研究和报道。我们的目的是分析八十多岁的患者接受根治性结直肠癌切除术后的结果，并与比他们年轻20岁的类似队列进行比较。
分析了2004年至2006年期间前瞻性收集的连续接受结直肠癌切除术患者数据库中的数据。主要终点是30天死亡率和发病率。次要终点是长期生存率。
确定了81例年龄大于80岁的连续患者和61例年龄在60 - 70岁之间接受择期和急诊手术的患者。在八十多岁的患者组中，75.3%的手术是择期手术，而较年轻队列中的这一比例为78.0%（p = 0.9），盆腔手术分别占34.6%和44.3%（p = 0.34）。老年人的CR-Possum（身体状况）中位数评分显著高于较年轻队列（18.0对14.0；p = 0.001）。永久性造口率相似（八十多岁的患者为22%，较年轻患者为27%；p = 0.8），病理分期也相似（p = 0.24）。每组各有1例患者在切除术后30天内死亡。八十多岁患者队列的中位生存期为73个月，较年轻队列的中位生存期为74个月，5年生存率分别为53.1%和66.0%（p = 0.2，Mantel-Cox检验）。CR-Possum评分不影响总体生存率（p = 0.711，Mantel-Cox检验），但评分越高，两组术后并发症越多。
八十多岁的患者身体状况较差，但可以接受手术切除，死亡率和发病率在可接受范围内。所研究的两个年龄组的总体生存率相似，身体状况较差与术后并发症较多相关，但在长期生存方面没有差异。
