加速康复时代下老年结直肠癌患者的短期预后

Short-Term Outcomes of Colorectal Resection for Cancer in Elderly in the Era of Enhanced Recovery.

机构信息

1 L'UNAM and University of Angers, Angers, France.

2 Department of Visceral Surgery, CHU Angers, Angers, France.

出版信息

Scand J Surg. 2018 Mar;107(1):31-37. doi: 10.1177/1457496917706010. Epub 2017 May 3.

DOI:10.1177/1457496917706010

PMID:28464708

Abstract

BACKGROUND AND AIMS

Early rehabilitation protocols should be assessed in elderly. We aimed to study the outcomes of colorectal surgery and the observance of the modalities of an early rehabilitation protocol in patients over 80 years.

MATERIAL AND METHODS

All consecutive patients who underwent surgery for colorectal cancer in our center over a 19-month period were included. All of these patients were managed using the same early rehabilitation protocol. Patients older than 80 were compared to younger patients.

RESULTS

A total of 173 patients were included and 36 were ≥80 years (20.8%). Patients aged ≥80 years had a significantly higher ASA score and were operated on in emergency. In the peroperative period, patients aged ≥80 years were more likely to undergo laparotomy than patients <80 years in univariate analysis (p = 0.048), but in multivariate analysis, the choice for a laparoscopy was influenced by ASA score ≤2 (odds ratio = 3.55, 95% confidence interval = 1.67-7.58) and emergency surgery (odds ratio = 0.18, 95% confidence interval = 0.06-0.50). In the postoperative period, peristalsis stimulation and vascular catheter ablation were significantly better followed in Group 1 (p = 0.012 and 0.031). However, in multivariate analysis, age was not significantly associated with these parameters. Peristalsis stimulation was influenced by ASA score ≥2 (odds ratio = 4.27, 95% confidence interval = 1.18-15.37) and vascular catheter ablation was also influenced by ASA score ≤2 (odds ratio = 2.63, 95% confidence interval = 1.33-5.21). Emergency surgery had a strong trend to influence these parameters (p = 0.08).

CONCLUSION

Although age or comorbidities may affect observance for certain modalities such as chewing gum use and vascular catheter ablation, an early rehabilitation protocol can be used after colorectal cancer surgery in patients ≥80 years old, where it would improve functional results and postoperative outcomes.

摘要

背景与目的

应评估老年患者的早期康复方案。我们旨在研究 80 岁以上患者结直肠手术后的结局以及早期康复方案模式的遵守情况。

材料与方法

在 19 个月的时间内，我们纳入了在中心接受结直肠癌手术的所有连续患者。所有这些患者均采用相同的早期康复方案进行管理。比较了年龄大于 80 岁的患者与年轻患者。

结果

共纳入 173 例患者，其中 36 例患者年龄≥80 岁（20.8%）。年龄≥80 岁的患者 ASA 评分较高，且手术为急诊手术。在围手术期，单因素分析中，年龄≥80 岁的患者比<80 岁的患者更有可能接受剖腹手术（p = 0.048），但多因素分析中，ASA 评分≤2 （优势比= 3.55，95%置信区间= 1.67-7.58）和急诊手术（优势比= 0.18，95%置信区间= 0.06-0.50）影响腹腔镜手术的选择。在术后期间，第 1 组的肠蠕动刺激和血管导管消融的随访情况明显更好（p = 0.012 和 0.031）。但是，在多因素分析中，年龄与这些参数无显著相关性。肠蠕动刺激受 ASA 评分≥2 的影响（优势比= 4.27，95%置信区间= 1.18-15.37），血管导管消融也受 ASA 评分≤2 的影响（优势比= 2.63，95%置信区间= 1.33-5.21）。急诊手术对这些参数有强烈的影响趋势（p = 0.08）。