Manceau Gilles, Hain Elisabeth, Maggiori Léon, Mongin Cécile, Prost À la Denise Justine, Panis Yves
Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Denis Diderot University (Paris VII), 100 Boulevard du Général Leclerc, 92110, Clichy, France.
Surg Endosc. 2017 Feb;31(2):632-642. doi: 10.1007/s00464-016-5009-4. Epub 2016 Jun 17.
Several studies showed that age is significantly associated with impaired outcomes after open colorectal surgery. However, very few data exist on laparoscopic rectal cancer surgery in elderly patients. The aim of this study was to assess operative results of laparoscopic rectal cancer surgery according to age.
From 2005 to 2014, 446 consecutive patients who underwent laparoscopic rectal cancer resection were identified from a prospective database. Five groups were defined: age <45 (n = 44), 45-54 (n = 80), 55-64 (n = 166), 65-74 (n = 95) and ≥75 years (n = 61).
Elderly patients presented significantly higher ASA score (p = 0.004), higher Charlson comorbidity index (p < 0.0001) and more frequent cardiovascular, pulmonary (p < 0.0001) and neurological (p = 0.03) comorbidities. Overall postoperative morbidity rate was similar between groups (34-35-37-43-43 %, p = 0.70). Medical morbidity slightly increased with age (14-9-14-19-26 %, p = 0.06), but there was no significant difference regarding clinical anastomotic leakage, surgical morbidity, major morbidity (Dindo ≥3), cardiopulmonary complications and length of hospital stay. In multivariate analysis, age was not an independent factor for postoperative morbidity, unlike ASA score ≥3 (p = 0.039), neoadjuvant radiotherapy/chemoradiotherapy (p = 0.034) and operative time ≥240 min (p = 0.013).
This study showed that laparoscopic rectal cancer resection might safely be performed irrespective of age.
多项研究表明，年龄与开放性结直肠手术后预后受损显著相关。然而，关于老年患者腹腔镜直肠癌手术的数据却非常少。本研究的目的是根据年龄评估腹腔镜直肠癌手术的手术结果。
从2005年至2014年，从前瞻性数据库中确定了446例连续接受腹腔镜直肠癌切除术的患者。分为五组：年龄<45岁（n = 44）、45 - 54岁（n = 80）、55 - 64岁（n = 166）、65 - 74岁（n = 95）和≥75岁（n = 61）。
老年患者的美国麻醉医师协会（ASA）评分显著更高（p = 0.004），查尔森合并症指数更高（p < 0.0001），心血管、肺部（p < 0.0001）和神经（p = 0.03）合并症更常见。各组总体术后发病率相似（34% - 35% - 37% - 43% - 43%，p = 0.70）。医疗发病率随年龄略有增加（14% - 9% - 14% - 19% - 26%，p = 0.06），但在临床吻合口漏、手术发病率、严重发病率（Dindo≥3）、心肺并发症和住院时间方面无显著差异。在多变量分析中，与ASA评分≥3（p = 0.039）、新辅助放疗/化疗（p = 0.034）和手术时间≥240分钟（p = 0.013）不同，年龄不是术后发病的独立因素。
本研究表明，无论年龄大小，腹腔镜直肠癌切除术都可以安全进行。
