Yap Raymond, Oliva Karen, Wilkins Simon, McMurrick Paul J
1 Department of Surgery, Cabrini Monash University, Cabrini Hospital, Malvern, Victoria, Australia 2 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Dis Colon Rectum. 2016 Jun;59(6):501-7. doi: 10.1097/DCR.0000000000000578.
Surgery in the very elderly is a topic that has not been well studied, despite the steady rise in this population. With the rise in this population, there is now discussion on the safety of surgery in this cohort for colorectal cancer.
The purpose of this study was to investigate elective and nonelective colorectal cancer surgery outcomes in patients aged ≥90 years at both private and public hospitals in Melbourne, Victoria, Australia.
This was a retrospective analysis of patients aged ≥90 years who were included in the prospectively maintained Cabrini Monash University Department of Surgery colorectal neoplasia database for patients entered between January 2010 and February 2015. Comorbidity, ASA score, acuity of surgery, treatment, mortality, morbidity, and survival were analyzed.
This study was conducted in a tertiary referral hospital.
A total of 48 patients were identified from the database. The majority of these patients were women (58.0%), ASA score III to IV (91.7%), and treated in an elective setting (79.2%). The median age was 91.8 years.
We measured 30-day mortality, 180-day mortality, and perioperative morbidity.
Thirty-day mortality rate was 2.1%. The 180-day mortality rate was 10.4%. A total of 29.2% of patients had a perioperative complication. Median follow-up was 21 months (range, 13-54 months). In 180-day mortality, minimally invasive surgery was associated with a lower mortality rate vs open surgery (p = 0.043). Perioperative complications were associated with nonelective surgery (p = 0.045), open surgery procedures (p = 0.014), and higher stages of disease (p = 0.014). A total of 81.3% of patients were able to return home after surgery.
This was a retrospective study with the usual limitations; however, these have been minimized with the use of a high-quality, prospective data collection database. The median follow-up was 21 months.
Colorectal surgery was generally safe for nonagenarians in this study. This study demonstrates that excellent outcomes can be achieved in a selected group. Additional prospective studies with larger numbers and 5-year follow-up are recommended.
尽管老年人群数量稳步上升，但针对高龄患者的手术研究仍不够充分。随着这一人群数量的增加，目前对于该年龄段结直肠癌患者手术安全性的讨论日益增多。
本研究旨在调查澳大利亚维多利亚州墨尔本私立和公立医院中年龄≥90岁的患者接受择期和非择期结直肠癌手术的结果。
这是一项回顾性分析，研究对象为年龄≥90岁且纳入2010年1月至2015年2月前瞻性维护的卡布里尼莫纳什大学外科结直肠肿瘤数据库的患者。分析了合并症、美国麻醉医师协会（ASA）评分、手术急症程度、治疗方式、死亡率、发病率和生存率。
本研究在一家三级转诊医院进行。
从数据库中识别出48例患者。这些患者中大多数为女性（58.0%），ASA评分为III至IV级（91.7%），且接受择期治疗（79.2%）。中位年龄为91.8岁。
我们测量了30天死亡率、180天死亡率和围手术期发病率。
30天死亡率为2.1%。180天死亡率为10.4%。共有29.2%的患者出现围手术期并发症。中位随访时间为21个月（范围13 - 54个月）。在180天死亡率方面，与开放手术相比，微创手术的死亡率较低（p = 0.0）。围手术期并发症与非择期手术（p = 0.045）、开放手术方式（p = 0.014）以及疾病分期较高（p = 0.014）相关。共有81.3%的患者术后能够回家。
这是一项存在常见局限性的回顾性研究；然而，通过使用高质量的前瞻性数据收集数据库，这些局限性已降至最低。中位随访时间为21个月。
在本研究中，结直肠手术对九旬老人总体而言是安全的。本研究表明，特定群体能够取得良好的手术结果。建议开展更多样本量更大且随访5年的前瞻性研究。
