Aquina Christopher T, Becerra Adan Z, Xu Zhaomin, Boscoe Francis P, Schymura Maria J, Noyes Katia, Monson John R T, Fleming Fergal J
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Surgical Health Outcomes and Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, NY.
Surgery. 2017 Jun;161(6):1609-1618. doi: 10.1016/j.surg.2017.01.001. Epub 2017 Feb 23.
Little is known regarding recent trends in the rate of nonelective colon cancer resection in the United States and its impact on both short-term and long-term outcomes.
The New York State Cancer Registry and Statewide Planning & Research Cooperative System identified stage I-III colon cancer resections from 2004-2011. Propensity-matched analyses assessed differences in short-term adverse outcomes and 5-year disease-specific and overall survival between elective and nonelective colon cancer operations. Further analyses assessed the association among patient, surgeon, and hospital-level factors and outcomes within the nonelective operation group.
Among 26,420 patients, 26.5% underwent nonelective operations. There was no significant change in the rate of nonelective resection from 2004-2011 (P = .25). Nonelective operations were independently associated with greater odds of 30-day mortality (odds ratio [OR] = 3.42, 95% confidence interval [CI] = 2.87-4.06), stoma creation (OR = 4.49, 95% CI = 3.95-5.09), intensive care unit admission (OR = 1.68, 95% CI = 1.53-1.84), complications (OR = 2.34, 95% CI = 2.18-2.52), and discharge to another health care facility (OR = 2.46, 95% CI = 2.26-2.68), longer duration of stay (incidence rate ratio = 1.79, 95% CI = 1.76-1.83), and worse disease-specific (hazard ratio = 1.74, 95% CI = 1.61-1.88) and overall survival (hazard ratio = 1.64, 95% CI = 1.55-1.75). Other than an association among high-volume surgeons, adequate lymph node yield, and receipt of adjuvant chemotherapy and lower mortality, no other potentially modifiable factors were associated with survival after nonelective operations.
Nonelective colon cancer resection remains a concerning public health issue with >25% of cases being performed on a nonelective basis and an independent association with poor short-term and long-term survival compared with elective operations. Given that few potentially modifiable factors appear to have an impact on survival after nonelective operations, these findings highlight the importance of adherence to colon cancer screening guidelines to limit the number of nonelective colon cancer resections.
关于美国非选择性结肠癌切除术的发生率及其对短期和长期结局的影响，目前所知甚少。
纽约州癌症登记处和全州规划与研究合作系统确定了2004年至2011年期间I - III期结肠癌切除术。倾向评分匹配分析评估了选择性和非选择性结肠癌手术在短期不良结局以及5年疾病特异性生存率和总生存率方面的差异。进一步分析评估了非选择性手术组中患者、外科医生和医院层面因素与结局之间的关联。
在26420例患者中，26.5%接受了非选择性手术。2004年至2011年期间非选择性切除术的发生率没有显著变化（P = 0.25）。非选择性手术与30天死亡率（比值比[OR]=3.42，95%置信区间[CI]=2.87 - 4.06）、造口形成（OR = 4.49，95% CI = 3.95 - 5.09）、入住重症监护病房（OR = 1.68，95% CI = 1.53 - 1.84）、并发症（OR = 2.34，95% CI = 2.18 - 2.52）以及转至另一家医疗机构（OR = 2.46，95% CI = 2.26 - 2.68）的较高几率独立相关，住院时间更长（发病率比 = 1.79，95% CI = 1.76 - 1.83），疾病特异性生存率更差（风险比 = 1.74，95% CI = 1.61 - 1.88）以及总生存率更差（风险比 = 1.64，95% CI = 1.55 - 1.75）。除了高手术量外科医生、足够的淋巴结获取数量、接受辅助化疗与较低死亡率之间存在关联外，没有其他潜在可改变的因素与非选择性手术后的生存相关。
非选择性结肠癌切除术仍然是一个令人担忧的公共卫生问题，超过25%的病例是在非选择性基础上进行的，并且与选择性手术相比，其与短期和长期生存不良独立相关。鉴于几乎没有潜在可改变的因素似乎对非选择性手术后的生存有影响，这些发现凸显了遵守结肠癌筛查指南以限制非选择性结肠癌切除术数量的重要性。
