Duraes Leonardo C, Stocchi Luca, Dietz David, Kalady Matthew F, Kessler Hermann, Schroeder Destiny, Remzi Feza H
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Ann Surg Oncol. 2016 Dec;23(13):4293-4301. doi: 10.1245/s10434-016-5445-3. Epub 2016 Jul 26.
Risks and benefits of colorectal cancer resection in octogenarians are not clearly defined. This study aimed to assess the relationship between morbidity and mortality within 1 year after colorectal cancer resection in octogenarians compared with other age groups.
A single-institution, prospectively maintained database was queried to identify patients with sporadic, pathological stages I-III colorectal adenocarcinoma, electively undergoing radical resection with curative intent between 2000 and 2012. Patients were divided into three age groups: 'octogenarians' if ≥80 years of age; 'intermediate' if ≥65 and <80 years of age; and 'younger' if <65 years of age.
Overall, 2485 patients fulfilled the inclusion criteria-326 in the octogenarian age group, 949 in the intermediate age group, and 1210 in the younger age group. Postoperative morbidity disproportionally increased 1-year mortality in octogenarians when compared with the younger age group (37 vs. 6.5 %; p < 0.001). Anastomotic leak, abdominopelvic abscess, reoperation, and readmission rates were comparable among different age groups, but were associated with a disproportionate risk of 1-year mortality in octogenarians (67, 43, 33, and 41 %, respectively). Multivariate analysis indicated that older age and postoperative complications were the only two independent variables associated with 30- and 90-day mortality. Besides these, American Society of Anesthesiologists (ASA) and pathological stage III were additional independent variables associated with 1-year mortality. An interaction test confirmed that age and postoperative complications were independent variables, with additive effect on 30-day, 90-day, and 1-year mortality.
Age plays an important and independent role in affecting mortality when complications occur following surgery for colorectal cancer. The full magnitude of postoperative risks should be taken into consideration when discussing colorectal cancer surgery in octogenarians.
八十多岁老人行结直肠癌切除术的风险和益处尚未明确界定。本研究旨在评估八十多岁老人与其他年龄组相比，结直肠癌切除术后1年内的发病率与死亡率之间的关系。
查询一个单机构前瞻性维护的数据库，以识别2000年至2012年间因治疗目的而接受根治性切除术的散发性、病理分期为I-III期结直肠腺癌患者。患者分为三个年龄组：年龄≥80岁为“八十多岁老人组”；年龄≥65岁且<80岁为“中年组”；年龄<65岁为“年轻组”。
总体而言，2485例患者符合纳入标准，其中八十多岁老人组326例，中年组949例，年轻组1210例。与年轻组相比，八十多岁老人术后发病率不成比例地增加了1年死亡率（37%对6.5%；p<0.001）。不同年龄组之间吻合口漏、腹盆腔脓肿、再次手术和再入院率相当，但与八十多岁老人1年死亡风险不成比例相关（分别为67%、43%、33%和41%）。多因素分析表明，年龄较大和术后并发症是与30天和90天死亡率相关的仅有的两个独立变量。除此之外，美国麻醉医师协会（ASA）分级和病理III期是与1年死亡率相关的额外独立变量。交互作用检验证实年龄和术后并发症是独立变量，对30天、90天和1年死亡率有相加作用。
年龄在结直肠癌手术后出现并发症时影响死亡率方面起着重要且独立的作用。在讨论八十多岁老人的结直肠癌手术时，应充分考虑术后风险的全部程度。
