Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway.
Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
Colorectal Dis. 2018 Jan;20(1):16-25. doi: 10.1111/codi.13785.
Colorectal cancer (CRC) is prevalent in the older population, and surgery is the mainstay of curative treatment. A preoperative geriatric assessment (GA) can identify frail older patients at risk for developing postoperative complications. In this randomized controlled trial we wanted to investigate whether tailored interventions based on a preoperative GA could reduce the frequency of postoperative complications in frail patients operated on for CRC.
Patients > 65 years scheduled for elective CRC surgery and fulfilling predefined criteria for frailty were randomized to either a preoperative GA followed by a tailored intervention or care as usual. The primary end-point was Clavien-Dindo Grade II-V postoperative complications. Secondary end-points included complications of any grade, reoperation, length of stay, readmission and survival.
One hundred and twenty-two patients with a mean age of 78.6 years were randomized. We found no statistically significant differences between the intervention group and the control group for Grade II-V complications (68% vs 75%, P = 0.43), reoperation (19% vs 11%, P = 0.24), length of stay (8 days in both groups), readmission (16% vs 6%, P = 0.12) or 30-day survival (4% vs 5%, P = 0.79). Grade I-V complications occurred in 76% of patients in the intervention group compared with 87% in the control group (P = 0.10). In secondary analyses adjusting for prespecified prognostic factors, there was a statistically significant difference in favour of the intervention for reducing the total number of Grade I-V complications (P = 0.05).
A preoperative GA and tailored interventions did not reduce the rate of Grade II-V complications, reoperations, readmission or mortality in frail older patients electively operated on for CRC.
结直肠癌（CRC）在老年人群中较为常见，手术是主要的治愈性治疗方法。术前老年综合评估（GA）可以识别出有术后并发症风险的虚弱老年患者。在这项随机对照试验中，我们想研究基于术前 GA 的个体化干预措施是否可以减少 CRC 虚弱患者术后并发症的发生频率。
我们将计划接受择期 CRC 手术且符合预先定义的虚弱标准的>65 岁患者随机分为术前 GA 加个体化干预组或常规治疗组。主要终点是 Clavien-Dindo II-V 级术后并发症。次要终点包括任何级别的并发症、再次手术、住院时间、再入院和生存率。
共纳入 122 例平均年龄为 78.6 岁的患者。我们发现干预组和对照组之间 II-V 级并发症（68%比 75%，P=0.43）、再次手术（19%比 11%，P=0.24）、住院时间（两组均为 8 天）、再入院率（16%比 6%，P=0.12）或 30 天生存率（4%比 5%，P=0.79）均无统计学差异。干预组有 76%的患者发生了 I-V 级并发症，而对照组为 87%（P=0.10）。在调整了预设预后因素的二次分析中，干预组在减少 I-V 级总并发症数量方面具有统计学显著差异（P=0.05）。
术前 GA 和个体化干预措施并不能降低 CRC 择期手术虚弱老年患者的 II-V 级并发症、再次手术、再入院或死亡率。
