De Blasi Vito, Memeo Riccardo, Adam René, Goéré Diane, Cherqui Daniel, Regimbeau Jean Marc, Rivoire Michel, Perotto Laura Ornella, Navarro Francis, Sa Cunha Antonio, Pessaux Patrick
Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France.
Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg, France.
Dig Surg. 2018;35(4):333-341. doi: 10.1159/000486522. Epub 2018 Apr 17.
The aim of this study was to evaluate the results of major hepatectomies for metastasis in elderly colorectal cancer patients, for whom limited data exist in the literature.
From January 2006 to January 2013, 3,034 patients underwent hepatectomy for colorectal liver metastasis in 32 French surgical centers. Repeat hepatectomies were excluded from the study. Based on a 1: 4 propensity score matching model, 42 patients aged ≥80 (OG) were matched with 168 patients <80 years (YG) in order to obtain 2 well-balanced and homogeneous groups with regards to therapy and prognostic factors.
The unmatched cohort consisted of 744 patients (OG: n = 42; YG: n = 702). After PS matching, there was no difference in terms of general morbidity, rates of Dindo-Clavien score ≥III (OG: 16% vs. YG: 21%, p = 0.663), surgical morbidity (OG: 16% vs. YG: 21%, p = 0.663), reoperation (OG:10% vs. YG: 5%, p = 0.263), 90-day mortality (OG: 0% vs. YG:2%, p = 1), and total median hospital stay (OG: 12 vs. YG: 12, p = 0.972). Both groups experienced similar 3- and 5-year overall survival (82 and 82% OG vs.78 and 67% YG) and disease-free survival (40 and 35% OG vs. 45 and 35% YG at 3 and 5 years).
No difference in perioperative and postoperative outcomes and disease-free and overall survival was found. Major hepatectomy in selected octogenarian patients is safe and feasible.
本研究旨在评估老年结直肠癌患者肝转移行肝大部切除术的结果，目前该领域文献数据有限。
2006年1月至2013年1月，32个法国外科中心的3034例患者因结直肠癌肝转移接受肝切除术。再次肝切除术被排除在研究之外。基于1:4倾向评分匹配模型，42例年龄≥80岁（老年组）的患者与168例年龄<80岁（青年组）的患者进行匹配，以获得在治疗和预后因素方面平衡且同质的两组。
未匹配队列包括744例患者（老年组：n = 42；青年组：n = 702）。倾向评分匹配后，两组在总体发病率、Dindo-Clavien评分≥III级的发生率（老年组：16% vs. 青年组：21%，p = 0.663）、手术发病率（老年组：16% vs. 青年组：21%，p = 0.663）、再次手术率（老年组：10% vs. 青年组：5%，p = 0.263）、90天死亡率（老年组：0% vs. 青年组：2%，p = 1）以及总中位住院时间（老年组：12天 vs. 青年组：12天，p = 0.972）方面均无差异。两组的3年和5年总生存率（老年组分别为82%和82%，青年组分别为78%和67%）及无病生存率（老年组3年和5年分别为40%和35%，青年组分别为45%和35%）相似。
围手术期和术后结果以及无病生存率和总生存率均无差异。对选定的八旬老人行肝大部切除术是安全可行的。
