腹腔镜右半结肠切除术治疗癌症后年龄的影响：是否存在特定结局？

Effects of age after laparoscopic right colectomy for cancer: Are there any specific outcomes?

作者信息

Denet Christine, Fuks David, Cocco Francesca, Chopinet Sophie, Abbas Marcel, Costea Cyprian, Levard Hugues, Perniceni Thierry, Gayet Brice

机构信息

Department of Digestive Disease, Institute Mutualiste Montsouris, Paris Descartes University, Paris, France.

出版信息

Dig Liver Dis. 2017 May;49(5):562-567. doi: 10.1016/j.dld.2016.12.014. Epub 2016 Dec 21.

DOI:10.1016/j.dld.2016.12.014

PMID:28065524

Abstract

BACKGROUND

Laparoscopic approach in colorectal surgery has demonstrated to give advantages in terms of postoperative outcomes, particularly in high-risk patients. The aim was to assess the impact of patients' age on the short-term outcomes after laparoscopic right colectomy for cancer.

METHODS

From January 2004 to September 2014, all patients who underwent laparoscopic right colectomy for cancer in a single institution were divided into four groups (A: <64 years; B: 65-74 years; C: 75-84 years; D ≥85 years). Risk factors for postoperative complications were determined on multivariable analysis.

RESULTS

Laparoscopic right colectomy was performed in 507 patients, including 171 (33.7%) in A, 168 (33.1%) in B, 131 (25.8) in C and 37 (7.4%) in D. Patients in Group C and Group D had higher ASA score (p<0.0001) and presented more frequently with anaemia (20.6% and 29.7%, p=0.001). Stages III and IV were more frequently encountered in groups C and D. Overall morbidity was 27.5% without any difference in the four groups (24.5%, 29.1%, 7.5% and 18.4% respectively, p=0.58). The rate of minor complications (such as wound infection or postoperative ileus) was higher in Group D compared to other groups (p=0.05). The only independent variable correlated with postoperative morbidity was intraoperative blood transfusion (OR 2.82; CI 95% 1.05-4.59, p<0.0001).

CONCLUSIONS

The present series suggests that patient's age did not significantly jeopardize the postoperative outcomes after laparoscopic right colectomy for cancer.

摘要

背景

结直肠癌手术的腹腔镜入路已证明在术后结果方面具有优势，尤其是在高危患者中。目的是评估患者年龄对腹腔镜右半结肠癌切除术短期结果的影响。

方法

2004年1月至2014年9月，在单一机构接受腹腔镜右半结肠癌切除术的所有患者被分为四组（A组：<64岁；B组：65 - 74岁；C组：75 - 84岁；D组：≥85岁）。通过多变量分析确定术后并发症的危险因素。

结果

507例患者接受了腹腔镜右半结肠癌切除术，其中A组171例（33.7%），B组168例（33.1%），C组131例（25.8%），D组37例（7.4%）。C组和D组患者的美国麻醉医师协会（ASA）评分更高（p<0.0001），贫血发生率更高（分别为20.6%和29.7%，p = 0.001）。C组和D组中III期和IV期病例更常见。总体发病率为27.5%，四组之间无差异（分别为24.5%、29.1%、7.5%和18.4%，p = 0.58）。与其他组相比，D组的轻微并发症（如伤口感染或术后肠梗阻）发生率更高（p = 0.05）。与术后发病率相关的唯一独立变量是术中输血（比值比2.82；95%可信区间1.05 - 4.59，p<0.0001）。