经肛门内镜微创手术治疗老年和超高龄患者：一种安全的选择吗？前瞻性数据收集的观察性研究。
Transanal endoscopic micro-surgery in elderly and very elderly patients: a safe option? Observational study with prospective data collection.
机构信息
Coloproctology Unit, General and Digestive Surgery Department, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, Parc Tauli s/n, 08208, Sabadell, Barcelona, Spain.
General and Digestive Surgery Department, Parc Tauli University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain.
出版信息
Surg Endosc. 2019 Jan;33(1):184-191. doi: 10.1007/s00464-018-6292-z. Epub 2018 Jun 22.
BACKGROUND
Although the incidence of colorectal cancer increases with the patient's age, the elderly continue to be less likely to be scheduled for surgery. Transanal endoscopic micro-surgery (TEM) is a surgical alternative to total mesorectal excision (TME) in early stage rectal cancer and/or in selected patients that could decrease morbidity and mortality rates in this group of patients. Our main objective is to assess the safety and feasibility of TEM in elderly (75-84 years) and very elderly (≥ 85 years) patients.
METHODS
Observational study was conducted with prospective data collection of all consecutive patients who underwent TEM between April 2004 and January 2017. Patients were assigned to groups according to age. Descriptive and comparative analyses between groups were performed.
RESULTS
We analyzed 693 patients, 429 patients < 75 years (61.9%), 220 patients between the ages of 75 and 84 (31.7%), and 44 patients ≥ 85 years old (6.3%). The tendency in our series is to increase comorbidities with age. Palliative or consensus intent was more frequently performed in elderly (10.5%, 34/220), and very elderly (45.4%, 20/44), compared with the youngest (6.3%, 27/429), (p < 0.001). Global morbidity presented an increasing trend related to age from 20.3% in < 75 years, to 25.9% in elderly and 34.1% in very elderly. Surgical complications were recorded in 18.5% (128/693) of patients with no significant differences between groups. The most common one was rectal bleeding 16.1% (111/693). Significant differences were found in non-surgical complications, recorded in 7.3% (16/220) in the elderly, and 15.9% (7/44) in the group above 84 years (p = 0.013).
CONCLUSIONS
TEM presents acceptable morbidity rates mainly due to non-surgical-related adverse effects in elderly and very elderly patients and may be a feasible and safe alternative in this population in both curative and non-curative indications.
背景
尽管结直肠癌的发病率随患者年龄的增长而增加，但老年人接受手术的可能性仍然较低。经肛门内镜微创手术（TEM）是早期直肠癌和/或某些特定患者全直肠系膜切除术（TME）的替代手术，可降低该组患者的发病率和死亡率。我们的主要目的是评估 TEM 在老年（75-84 岁）和非常老年（≥85 岁）患者中的安全性和可行性。
方法
本研究为前瞻性观察研究，收集了 2004 年 4 月至 2017 年 1 月期间所有连续接受 TEM 治疗的患者的连续数据。根据年龄将患者分为两组。对两组间进行描述性和比较分析。
结果
我们共分析了 693 例患者，其中 429 例年龄<75 岁（61.9%），220 例年龄在 75-84 岁之间（31.7%），44 例年龄≥85 岁（6.3%）。在我们的研究系列中，随着年龄的增长，合并症的发生率呈上升趋势。与最年轻的患者（6.3%，27/429）相比，老年（10.5%，34/220）和非常老年（45.4%，20/44）患者更倾向于姑息性或共识性手术（p<0.001）。总体发病率呈随年龄增加而升高的趋势，<75 岁患者为 20.3%，老年患者为 25.9%，非常老年患者为 34.1%。记录了 693 例患者中有 18.5%（128 例）发生了全身并发症，各组之间无显著差异。最常见的并发症是直肠出血，占 16.1%（111/693）。在非手术相关并发症方面，老年组有 7.3%（16/220），84 岁以上组有 15.9%（7/44），差异有统计学意义（p=0.013）。
结论
TEM 的并发症发生率可接受，主要是由于老年和非常老年患者与手术无关的不良反应所致，对于该人群的根治性和非根治性适应证，TEM 可能是一种可行且安全的替代治疗方法。
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