Devoto Laurence, Celentano Valerio, Cohen Richard, Khan Jim, Chand Manish
Department of Colorectal Surgery, University College London Hospitals, London, UK.
Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK.
Int J Colorectal Dis. 2017 Sep;32(9):1237-1242. doi: 10.1007/s00384-017-2848-y. Epub 2017 Jun 30.
Colorectal cancer is the second most common cause of death from neoplastic disease in men and third in women of all ages. Globally, life expectancy is increasing, and consequently, an increasing number of operations are being performed on more elderly patients with the trend set to continue. Elderly patients are more likely to have cardiovascular and pulmonary comorbidities that are associated with increased peri-operative risk. They further tend to present with more locally advanced disease, more likely to obstruct or have disseminated disease. The aim of this review was to investigate the feasibility of laparoscopic colorectal resection in very elderly patients, and whether there are benefits over open surgery for colorectal cancer.
A systematic literature search was performed on Medline, Pubmed, Embase and Google Scholar. All comparative studies evaluating patients undergoing laparoscopic versus open surgery for colorectal cancer in the patients population over 85 were included. The primary outcomes were 30-day mortality and 30-day overall morbidity. Secondary outcomes were operating time, time to oral diet, number of retrieved lymph nodes, blood loss and 5-year survival.
The search provided 1507 citations. Sixty-nine articles were retrieved for full text analysis, and only six retrospective studies met the inclusion criteria. Overall mortality for elective laparoscopic resection was 2.92% and morbidity 23%. No single study showed a significant difference between laparoscopic and open surgery for morbidity or mortality, but pooled data analysis demonstrated reduced morbidity in the laparoscopic group (p = 0.032). Patients undergoing laparoscopic surgery are more likely to have a shorter hospital stay and a shorter time to oral diet.
Elective laparoscopic resection for colorectal cancer in the over 85 age group is feasible and safe and offers similar advantages over open surgery to those demonstrated in patients of younger ages.
结直肠癌是所有年龄段男性因肿瘤疾病死亡的第二大常见原因，女性中则位列第三。在全球范围内，预期寿命不断增加，因此，越来越多的老年患者接受手术治疗，且这一趋势还将持续。老年患者更易患有心血管和肺部合并症，这与围手术期风险增加相关。他们还更倾向于出现局部进展期疾病，更有可能发生梗阻或出现播散性疾病。本综述的目的是研究在高龄患者中行腹腔镜结直肠癌切除术的可行性，以及与开放手术相比是否具有优势。
在Medline、Pubmed、Embase和谷歌学术上进行了系统的文献检索。纳入所有评估85岁以上人群中行腹腔镜与开放手术治疗结直肠癌患者的比较研究。主要结局为30天死亡率和30天总体发病率。次要结局为手术时间、开始经口饮食时间、获取的淋巴结数量、失血量和5年生存率。
检索共得到1507条引用文献。检索到69篇文章进行全文分析，只有6项回顾性研究符合纳入标准。择期腹腔镜切除术的总体死亡率为2.92%，发病率为23%。没有一项研究显示腹腔镜手术和开放手术在发病率或死亡率上有显著差异，但汇总数据分析表明腹腔镜组发病率降低（p = 0.032）。接受腹腔镜手术的患者住院时间更短，开始经口饮食的时间也更短。
85岁以上年龄组择期腹腔镜结直肠癌切除术是可行且安全的，与开放手术相比，其优势与年轻患者相似。
