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80岁以上患者行腹腔镜结直肠癌手术的安全性:一项倾向评分匹配研究。

Safety of laparoscopic surgery for colorectal cancer in patients over 80 years old: a propensity score matching study.

作者信息

Shiga Mai, Maeda Hiromichi, Oba Koji, Okamoto Ken, Namikawa Tsutomu, Fujisawa Kazune, Yokota Keiichiro, Kobayashi Michiya, Hanazaki Kazuhiro

机构信息

Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.

Cancer Treatment Center, Kochi Medical School Hospital, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.

出版信息

Surg Today. 2017 Aug;47(8):951-958. doi: 10.1007/s00595-017-1470-5. Epub 2017 Jan 27.

Abstract

PURPOSES

To establish the safety of laparoscopic-assisted colorectal resection for colorectal cancer in elderly patients aged ≥80 years.

METHODS

Data were obtained from a chart review of patients who underwent colorectal cancer resection between 2009 and 2014 in Kochi Medical School. The effect of patient age on the extent of lymph node dissection and operative safety was assessed by comparing the short-term results of elderly patients with those of younger patients after propensity score matching.

RESULTS

Of a total of 506 patients with colorectal cancer, 398 underwent laparoscopic surgery and 23% of these patients were aged ≥80 years old. The elderly patients tended to have poorer general condition and larger tumors, although no significant differences were found in tumor invasion, lymph node metastasis, or synchronous distant metastasis between the groups. After adjustment for preoperative factors, we noted that the elderly patients tended to undergo less aggressive surgical resection (P = 0.01). Further analysis after including surgical factors for propensity score matching revealed a similar rate of complications in the two groups (24 vs. 25%, respectively; P = 0.85), and similar postoperative death rates and length of postoperative hospital stay.

CONCLUSION

The findings of the present study demonstrate that laparoscopic surgery for colorectal cancer should not be avoided based on simply the age of the patient.

摘要

目的

确定≥80岁老年患者行腹腔镜辅助结直肠癌切除术的安全性。

方法

数据来自于高知医科大学2009年至2014年间接受结直肠癌切除术患者的病历回顾。通过倾向评分匹配后比较老年患者与年轻患者的短期结果,评估患者年龄对淋巴结清扫范围和手术安全性的影响。

结果

在总共506例结直肠癌患者中,398例行腹腔镜手术,其中23%的患者年龄≥80岁。老年患者的一般状况往往较差,肿瘤较大,尽管两组在肿瘤侵犯、淋巴结转移或同时性远处转移方面未发现显著差异。在对术前因素进行调整后,我们注意到老年患者倾向于接受侵袭性较小的手术切除(P = 0.01)。纳入手术因素进行倾向评分匹配后的进一步分析显示,两组的并发症发生率相似(分别为24%和25%;P = 0.85),术后死亡率和术后住院时间也相似。

结论

本研究结果表明,不应仅仅基于患者年龄而避免对结直肠癌患者进行腹腔镜手术。

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