Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
Eur J Surg Oncol. 2018 Dec;44(12):1894-1900. doi: 10.1016/j.ejso.2018.08.028. Epub 2018 Sep 8.
We implemented a multidisciplinary pre- and rehabilitation program for elderly patients (≥75 years of age) in a single center consisting of prehabilitation, laparoscopic surgery and early rehabilitation with the intention to lower 1-year overall mortality.
In this study we compared all patients that underwent elective surgery for stage I-III colorectal cancer before and during development and after implementation of the program (2010-2011, 2012-2013 and 2014-2015). Primary endpoint was 1-year overall mortality, the secondary endpoint was 30-day postoperative outcome.
Eighty-six consecutive patients were included in the study cohort and compared to 63 patients from 2010 to 2011 and 75 patients from 2012 to 2013. Patient characteristics were comparable; median age in the study cohort was 80.6. Seventy-three patients (85%) participated in the program, 54 (63%) of whom followed a prehabilitation program, 46 (53%) of whom were discharged to a rehabilitation center. Laparoscopic surgery increased over the years from 70% to 83% in the study cohort. There was a trend in lower 1-year overall mortality: 11% versus 3% (p=0.08). There was a significant reduction in cardiac complications and the number of patients with a prolonged length of stay (p < 0.01).
Multidisciplinary care for elderly colorectal cancer patients that includes prehabilitation and rehabilitation is feasible and may contribute to lower complications and reduced length of stay. This study did not show a clear benefit of implementing a comprehensive care program including both prehabilitation and rehabilitation. Dedicated multidisciplinary care seems the key attributer to favorable outcomes of CRC surgery in elderly patients.
我们在一家中心实施了一个多学科的老年患者（≥75 岁）术前和康复计划，包括术前康复、腹腔镜手术和早期康复，旨在降低 1 年总体死亡率。
在这项研究中，我们比较了在该计划实施前（2010-2011 年）、实施期间（2012-2013 年）和实施后（2014-2015 年）接受择期 I-III 期结直肠癌手术的所有患者。主要终点是 1 年总体死亡率，次要终点是术后 30 天的结果。
86 例连续患者被纳入研究队列，并与 2010 年至 2011 年的 63 例和 2012 年至 2013 年的 75 例患者进行比较。患者特征相似；研究队列的中位年龄为 80.6 岁。73 例（85%）患者参加了该计划，其中 54 例（63%）参加了术前康复计划，46 例（53%）出院至康复中心。腹腔镜手术的比例逐年从 70%增加到 83%。1 年总体死亡率呈下降趋势：11%比 3%（p=0.08）。心脏并发症和住院时间延长的患者数量显著减少（p<0.01）。
多学科护理包括术前和康复对于老年结直肠癌患者是可行的，可能有助于降低并发症发生率和缩短住院时间。本研究并未显示实施包括术前和康复在内的综合护理计划的明确益处。专门的多学科护理似乎是老年患者结直肠癌手术良好结果的关键因素。
