Lee Yoon Hyun, Oh Heung-Kwon, Kim Duck-Woo, Ihn Myong Hoon, Kim Jee Hyun, Son Il Tae, Kang Sung Il, Kim Gwang Il, Ahn Soyeon, Kang Sung-Bum
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Surgery, Soonchunhyang University Gumi Hospital, Gumi, Korea.
Ann Coloproctol. 2016 Oct;32(5):161-169. doi: 10.3393/ac.2016.32.5.161. Epub 2016 Oct 31.
This study was conducted to identify the effectiveness of a preoperative comprehensive geriatric assessment (CGA) for predicting postoperative morbidity in elderly patients who underwent surgery for colorectal cancer.
Elderly patients (≥70 years old) who underwent surgery for colorectal cancer at a tertiary hospital in Korea were identified, and their cases were analyzed using data from a prospectively collected database to establish an association between major postsurgical complications and 'high-risk' patient as defined by the CGA.
A total of 240 patients, with a mean age of 76.7 ± 5.2 years, were enrolled. Ninety-five patients (39.6%) were classified as "high-risk" and 99 patients (41.3%) as having postoperative complications. The univariate analysis indicated that risk factors for postoperative complications were age, American Society of Anesthesiologists physical status classification, serum hemoglobin, carcinoembryonic antigen, cancer stage, and "high-risk" status. The multivariable analyses indicated that "high-risk" status (odds ratio, 2.107; 95% confidence interval, 1.168-3.804; P = 0.013) and elevated preoperative carcinoembryonic antigen (odds ratio, 2.561; 95% confidence interval, 1.346-4.871, P = 0.004) were independently associated with postoperative complications. A multivariable analysis of the individual CGA domains indicated that high comorbidities and low activities of daily living were significantly related with postoperative complications.
A preoperative CGA indicating "high-risk" was associated with major postoperative complications in elderly patients who underwent surgery for colorectal cancer. Thus, using the CGA to identify elderly colorectal-cancer patients who should be given more care during postoperative management may be clinically beneficial.
本研究旨在确定术前综合老年评估（CGA）对预测接受结直肠癌手术的老年患者术后并发症的有效性。
确定在韩国一家三级医院接受结直肠癌手术的老年患者（≥70岁），并使用前瞻性收集的数据库中的数据对其病例进行分析，以建立术后主要并发症与CGA定义的“高危”患者之间的关联。
共纳入240例患者，平均年龄为76.7±5.2岁。95例患者（39.6%）被归类为“高危”，99例患者（41.3%）有术后并发症。单因素分析表明，术后并发症的危险因素包括年龄、美国麻醉医师协会身体状况分级、血清血红蛋白、癌胚抗原、癌症分期和“高危”状态。多因素分析表明，“高危”状态（比值比，2.107；95%置信区间，1.168 - 3.804；P = 0.013）和术前癌胚抗原升高（比值比，2.561；95%置信区间，1.346 - 4.871，P = 0.004）与术后并发症独立相关。对各个CGA领域的多因素分析表明，高合并症和低日常生活活动能力与术后并发症显著相关。
术前CGA显示“高危”与接受结直肠癌手术的老年患者术后主要并发症相关。因此，使用CGA来识别在术后管理期间应给予更多护理的老年结直肠癌患者可能在临床上有益。
