Fagard Katleen, Leonard Silke, Deschodt Mieke, Devriendt Els, Wolthuis Albert, Prenen Hans, Flamaing Johan, Milisen Koen, Wildiers Hans, Kenis Cindy
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
J Geriatr Oncol. 2016 Nov;7(6):479-491. doi: 10.1016/j.jgo.2016.06.001. Epub 2016 Jun 21.
Colorectal cancer surgery is frequently performed in the older population. Many older persons have less physiological reserves and are thus more susceptible to adverse postoperative outcomes. Therefore, it seems important to distinguish the fit patients from the more vulnerable or frail. The aim of this review is to examine the evidence regarding the impact of frailty on postoperative outcomes in older patients undergoing surgery for colorectal cancer. A systematic literature search of Medline Ovid was performed focusing on studies that examined the impact of frailty on postoperative outcomes after colorectal surgery in older people aged ≥65years. The methodological quality of the studies was evaluated using the MINORS quality assessment. Five articles, involving four studies and 486 participants in total, were included. Regardless of varying definitions of frailty and postoperative outcomes, the frail patients had less favourable outcomes in all of the studies. Compared to the non-frail group, the frail group had a higher risk of developing moderate to severe postoperative complications, had longer hospital stays, higher readmission rates, and decreased long-term survival rates. The results of this systematic review suggest the importance of assessing frailty in older persons scheduled for colorectal surgery because frailty is associated with a greater risk of postoperative adverse outcomes. We conclude that, although there is no consensus on the definition of frailty, assessing frailty in colorectal oncology seems important to determine operative risks and benefits and to guide perioperative management.
结直肠癌手术常在老年人群中进行。许多老年人的生理储备较少，因此更容易出现术后不良后果。所以，区分健康患者与更脆弱或虚弱的患者似乎很重要。本综述的目的是研究关于虚弱对老年结直肠癌手术患者术后结局影响的证据。对Medline Ovid进行了系统的文献检索，重点关注研究虚弱对≥65岁老年人结直肠手术后术后结局影响的研究。使用MINORS质量评估对研究的方法学质量进行评估。共纳入5篇文章，涉及4项研究和486名参与者。无论对虚弱和术后结局的定义如何不同，在所有研究中，虚弱患者的结局都较差。与非虚弱组相比，虚弱组发生中度至重度术后并发症的风险更高，住院时间更长，再入院率更高，长期生存率降低。这项系统综述的结果表明，在计划进行结直肠癌手术的老年人中评估虚弱很重要，因为虚弱与术后不良结局的风险更高相关。我们得出结论，虽然对虚弱的定义尚无共识，但在结直肠肿瘤学中评估虚弱对于确定手术风险和益处以及指导围手术期管理似乎很重要。
