Yen Clarence, Simillis Constantinos, Choudhry Mariam, Mills Sarah, Warren Oliver, Tekkis Paris P, Kontovounisios Christos
a Department of Surgery and Cancer , Chelsea and Westminster Hospital, Imperial College London NHS Trust , London , UK.
b Department of Colorectal Surgery , The Royal Marsden NHS Foundation Trust , London , UK.
Acta Chir Belg. 2017 Oct;117(5):303-307. doi: 10.1080/00015458.2017.1321269. Epub 2017 May 11.
Colorectal Cancer (CRC) is a disease of the elderly, and with an ageing population, oncological surgical procedures for CRC in the elderly is expected to increase. However, the balance between surgical benefits and risks associated with age and comorbidities in elderly patients is obscure.
A retrospective database of consecutive patients who received CRC surgery was used to compare short-term surgical and oncological outcomes between patients aged ≥75 and <75 years old undergoing CRC resection.
There were 54 patients (63.5%) in the <75 group and 31 patients (36.5%) in the ≥75 group. Overall, there were no differences between the <75 and ≥75 groups in postoperative HDU/ITU stay, median hospital LOS or 30-day mortality rates. Patients ≥75 had a higher preoperative performance status (25.9% versus 71.0%, p < .001), but no difference in ASA Grade and referral pattern, proportion of emergency operations, cancer staging, resection margins, achievement of curative resection or median lymph node yield. There was a significantly higher use of adjuvant chemotherapy in the <75 age group (48.1% versus 25.8%, p = .043).
With adequate patient selection, CRC resection in elderly patients is not associated with higher postoperative mortality or worse short-term oncological benefits.
结直肠癌(CRC)是一种老年疾病,随着人口老龄化,老年患者的CRC肿瘤外科手术预计会增加。然而,老年患者手术获益与年龄及合并症相关风险之间的平衡尚不清楚。
使用接受CRC手术的连续患者的回顾性数据库,比较年龄≥75岁和<75岁接受CRC切除患者的短期手术和肿瘤学结局。
<75岁组有54例患者(63.5%),≥75岁组有31例患者(36.5%)。总体而言,<75岁组和≥75岁组在术后HDU/ITU住院时间、中位住院时间或30天死亡率方面无差异。≥75岁的患者术前功能状态较高(25.9%对71.0%,p<0.001),但在ASA分级和转诊模式、急诊手术比例、癌症分期、切缘、根治性切除的实现或中位淋巴结收获方面无差异。<75岁年龄组辅助化疗的使用显著更高(48.1%对25.8%,p = 0.043)。
通过适当的患者选择,老年患者的CRC切除与术后更高死亡率或更差的短期肿瘤学获益无关。