75岁以上直肠癌患者的最佳肿瘤治疗：基于肿瘤老年医学评估策略的结果

Optimal oncologic treatment of rectal cancer in patients over 75 years old: Results of a strategy based on oncogeriatric evaluation.

作者信息

Suhool A, Moszkowicz D, Cudennec T, Vychnevskaia K, Malafosse R, Beauchet A, Julié C, Peschaud F

机构信息

Service de chirurgie digestive, oncologique et metabolique, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France.

Service de chirurgie digestive, oncologique et metabolique, hôpital Ambroise-Paré, AP-HP, 92100 Boulogne-Billancourt, France; UVSQ, université Paris-Saclay, UFR des sciences de la santé Simone Veil, 78180 Montigny-Le-Bretonneux, France.

出版信息

J Visc Surg. 2018 Feb;155(1):17-25. doi: 10.1016/j.jviscsurg.2017.06.005. Epub 2018 Mar 2.

DOI:10.1016/j.jviscsurg.2017.06.005

PMID:29503170

Abstract

BACKGROUND

Few data are available on the management of elderly rectal cancer patients, and especially on the ability to provide optimal oncological treatment. The aim of this study was to determine the feasibility and results of multimodality treatment for rectal cancer in patients 75years and older after simplified comprehensive geriatric assessment (CGA) according to Balducci score.

METHODS

We reviewed the charts of elderly patients who underwent surgery for localized middle or low rectal cancer. Patients were classified into three CGA groups depending on their functional reserve, comorbidities, geriatric syndromes, and life expectancy.

RESULTS

Neoadjuvant therapy was discussed for 27 patients (47%), but only 56% of them were treated, including 8, 7, and 1 patient from CGA groups 1, 2, and 3, respectively. Fifty-three patients (93%) underwent sphincter-preserving surgical resection and four patients underwent abdominoperineal resection (7%). Postoperative complications were observed in 21 patients (37%). The postoperative complication rate was correlated non-significantly with age (<85years: 40.6%; ≥85years: 57.1%; P=0.3), and with the CGA (P=0.64). In total, 10 patients (18%) had definitive colostomy, including five anastomotic leakages (9%), and one incontinence (2%). The total rate of sphincter preservation was 82% (n=47). The risk of secondary definitive colonic stoma formation was not correlated with CGA (group 1: 14%; group 2/3: 16%; P=0.8). Estimated OS at five years was 52%.

CONCLUSIONS

After routine geriatric assessment, elderly rectal cancer patients have good rates of sphincter conservation and acceptable morbidity/mortality.

摘要

背景

关于老年直肠癌患者的管理，尤其是提供最佳肿瘤治疗的能力，现有数据较少。本研究的目的是确定根据巴尔杜奇评分进行简化综合老年评估后，75岁及以上直肠癌患者多模式治疗的可行性和结果。

方法

我们回顾了接受局部中低位直肠癌手术的老年患者的病历。根据患者的功能储备、合并症、老年综合征和预期寿命，将患者分为三个综合老年评估组。

结果

27例患者（47%）讨论了新辅助治疗，但其中仅56%接受了治疗，分别包括综合老年评估组1、2和3中的8例、7例和1例患者。53例患者（93%）接受了保肛手术切除，4例患者接受了腹会阴联合切除术（7%）。21例患者（37%）出现术后并发症。术后并发症发生率与年龄无显著相关性（<85岁：40.6%；≥85岁：57.1%；P=0.3），与综合老年评估也无显著相关性（P=0.64）。共有10例患者（18%）进行了永久性结肠造口术，包括5例吻合口漏（9%）和1例失禁（2%）。保肛总率为82%（n=47）。二次永久性结肠造口形成的风险与综合老年评估无关（组1：14%；组2/3：16%；P=0.8）。五年估计总生存率为52%。