Lim Sang Woo, Kim Young Jin, Kim Hyeong Rok
Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, Gwangju, Korea.
Ann Surg Treat Res. 2017 Jun;92(6):423-428. doi: 10.4174/astr.2017.92.6.423. Epub 2017 May 29.
The aim of this study was to compare the outcomes between patients under 60 years of age and older patients over 80 years of age who underwent laparoscopic colorectal surgery with colorectal cancer.
A retrospective analysis of 519 colorectal patients who underwent laparoscopic colorectal surgery for colorectal adenocarcinoma between January 2007 and December 2012 was collected and categorized into 2 groups of patients, those under 60 years of age (n = 404) and those over 80 years of age (n = 115).
The group of patients over 80 years of age had a significantly higher ASA physical status classification (P < 0.001), more preoperative comorbidities (P < 0.001), had a tendency towards more tumors in a colonic location (P = 0.034), and more advanced American Joint Committee on Cancer TNM stage (P = 0.001). A higher proportion of right hemicolectomy and abdominoperineal resection was performed and more transfusions were required in the group of patients over 80 years of age (P = 0.002 and P = 0.001, respectively). There were no significant differences in operative time, conversion rate, resection margins, and numbers of harvested lymph nodes, hospital stay, and morbidity between the 2 groups. No postoperative mortality was found in the present study. The 3-year DFS for over 80 years age group and under 60 years age group were 73.5% and 73.9%, respectively (P = 0.770).
Laparoscopic colorectal surgery was effective and safe for elderly patients over 80 years of age and resulted in postoperative outcomes similar to those in younger patients. The postoperative morbidity after laparoscopic colorectal cancer surgery was not increased in over 80 years of age.
本研究旨在比较60岁以下和80岁以上接受腹腔镜结直肠癌手术患者的手术结果。
回顾性分析2007年1月至2012年12月间519例行腹腔镜结直肠癌手术的患者,将其分为两组,60岁以下患者(n = 404)和80岁以上患者(n = 115)。
80岁以上患者组的美国麻醉医师协会(ASA)身体状况分级显著更高(P < 0.001),术前合并症更多(P < 0.001),结肠部位肿瘤倾向更多(P = 0.034),且美国癌症联合委员会(AJCC)TNM分期更晚(P = 0.001)。80岁以上患者组进行右半结肠切除术和腹会阴联合切除术的比例更高,输血需求更多(分别为P = 0.002和P = 0.001)。两组在手术时间、中转率、切缘、清扫淋巴结数量、住院时间和并发症发生率方面无显著差异。本研究中未发现术后死亡病例。80岁以上年龄组和60岁以下年龄组的3年无病生存率分别为73.5%和73.9%(P = 0.770)。
腹腔镜结直肠癌手术对80岁以上老年患者有效且安全,术后结果与年轻患者相似。80岁以上患者腹腔镜结直肠癌手术后的并发症发生率并未增加。