Hoshino Nobuaki, Fukui Yudai, Hida Koya, Sakai Yoshiharu
Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Int J Colorectal Dis. 2019 Mar;34(3):377-386. doi: 10.1007/s00384-019-03234-0. Epub 2019 Jan 16.
Laparoscopic surgery for colorectal cancer has spread globally. The usefulness of laparoscopic surgery for elderly patients was initially indicated by comparison with open surgery. However, whether the procedure is safe for elderly as well as non-elderly patients with colorectal cancer remains unclear.
In this review, patients aged ≥ 75 were defined as elderly. We conducted literature searches using PubMed, Scopus, and the Cochrane Central Register of Clinical Trials. Two authors independently reviewed resultant articles to identify relevant observational studies. Data synthesis was performed with a random-effects model. Heterogeneity was investigated by using forest plots and I statistics. Risk of bias of included studies was assessed by the Risk of Bias Assessment Tool for Nonrandomized Studies. Publication bias was assessed by funnel plots.
Twenty-two studies were included. The incidence of overall complications was slightly higher in elderly patients than in non-elderly patients, with statistical significance (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.08-1.34). There was no difference between them in the incidence of anastomotic leakage (RR 1.24, 95% CI 0.86-1.80) and mortality (risk difference 0.00, 95% CI - 0.01 to 0.01).
Laparoscopic surgery for colorectal cancer is mostly safe for elderly patients as well as non-elderly patients. Preoperative comorbidities or poor physical capacity should be cared for in the elderly.
腹腔镜结直肠癌手术已在全球范围内广泛开展。腹腔镜手术对老年患者的有效性最初是通过与开放手术对比得出的。然而，该手术对于老年和非老年结直肠癌患者是否安全仍不明确。
在本综述中，年龄≥75岁的患者被定义为老年患者。我们使用PubMed、Scopus和Cochrane临床试验中心注册库进行文献检索。两位作者独立审查所得文章以确定相关的观察性研究。采用随机效应模型进行数据合成。通过森林图和I统计量研究异质性。使用非随机研究偏倚风险评估工具评估纳入研究的偏倚风险。通过漏斗图评估发表偏倚。
纳入22项研究。老年患者总体并发症发生率略高于非老年患者，具有统计学意义（风险比（RR）1.20，95%置信区间（CI）1.08 - 1.34）。吻合口漏发生率（RR 1.24，95% CI 0.86 - 1.80）和死亡率（风险差0.00，95% CI -0.01至0.01）在两者之间无差异。
腹腔镜结直肠癌手术对老年和非老年患者大多是安全的。老年患者术前的合并症或身体状况较差的情况应予以关注。
