Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.
Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan.
J Gastrointest Surg. 2018 Nov;22(11):1958-1967. doi: 10.1007/s11605-018-3843-5. Epub 2018 Jun 25.
The number of patients aged ≥ 90 years is increasing worldwide; however, the treatment guidelines for colorectal cancer in elderly patients remain unclear. This study aimed to investigate the clinical outcomes of patients with primary colorectal cancer aged ≥ 90 years.
We retrospectively reviewed the medical records of 100 patients (aged ≥ 90 years) with primary colorectal adenocarcinoma. Their demographic and clinical characteristics and surgical outcomes were assessed.
The patients who underwent tumor resections (n = 71) showed longer overall and cancer-specific survival than those who underwent non-operative treatments (n = 29) (median overall survival time: 23.92 months vs. 2.99 months, P < 0.0001). Age, body mass index, performance status, advanced cancer stage (stages 3 and 4), and treatment strategy were identified as risk factors, prognostic factors, and predictors of overall survival. No significant differences in the postoperative morbidity rate, in-hospital mortality rate, and survival time were found between the elective laparoscopic (n = 27) and elective open (n = 37) surgery subgroups. However, the in-hospital mortality rate was 6.25% (4/64) in the patients who underwent elective open surgeries and 42.9% (3/7) in those who underwent emergent open surgeries (p = 0.0179).
In clinical practice, surgical treatment should not be denied to patients with primary colorectal cancer aged ≥ 90 years. However, the high complication and mortality rates for emergency surgeries act as a deterrent. Further studies to eliminate the bias between operative and non-operative groups may be needed to validate our results.
全球 90 岁以上老年患者的数量正在增加；然而，老年患者结直肠癌的治疗指南仍不明确。本研究旨在探讨原发结直肠腺癌 90 岁以上老年患者的临床结局。
我们回顾性分析了 100 例（年龄≥90 岁）原发性结直肠腺癌患者的病历。评估了他们的人口统计学和临床特征以及手术结果。
接受肿瘤切除术的患者（n=71）的总生存时间和癌症特异性生存时间长于接受非手术治疗的患者（n=29）（中位总生存时间：23.92 个月比 2.99 个月，P<0.0001）。年龄、体重指数、身体状况、晚期癌症分期（3 期和 4 期）和治疗策略被确定为总生存的危险因素、预后因素和预测因素。选择性腹腔镜手术（n=27）和选择性开腹手术（n=37）亚组的术后发病率、住院死亡率和生存时间无显著差异。然而，择期开腹手术的住院死亡率为 6.25%（4/64），急诊开腹手术的住院死亡率为 42.9%（3/7）（p=0.0179）。
在临床实践中，不应拒绝对 90 岁以上原发性结直肠癌患者进行手术治疗。然而，急诊手术的高并发症和死亡率是一个障碍。可能需要进一步的研究来消除手术组和非手术组之间的偏倚，以验证我们的结果。
