Emergency Surgery Department, "Sapienza" Medical School, Viale Policlinico 155, 00161, Rome, Italy.
Department of General Surgery, Sesto San Giovanni Hospital, Milan, Italy.
Aging Clin Exp Res. 2020 Feb;32(2):265-273. doi: 10.1007/s40520-019-01195-6. Epub 2019 Apr 13.
The enhanced recovery after surgery (ERAS) is nowadays a widely accepted multimodal programme of care in colorectal surgery, but still there is some reluctance in its application to very elderly patients.
The aim of this study is to investigate short-term outcomes of laparoscopic resection for colorectal cancer in octogenarian patients within the ERAS programme.
Data on 162 consecutive patients aged ≥ 80 years receiving elective minimally invasive colorectal resections within ERAS programme were collected in a multicentre, retrospective database in the period 2008-2017 in Italy. Univariate and multivariate analyses were performed to assess possible risk factors for poor clinical outcomes.
The postoperative minor morbidity rate (Clavien-Dindo 1 and 2) was 25.9%. The incidence of postoperative major morbidity rate (severe medical and surgical complications defined as Clavien-Dindo 3 and 4) accounted 6.1% and only 1.8% had an anastomotic leakage. Reoperation rate was 5.5%, perioperative 30-day mortality was 1.8%, and 30-day readmission rate was 6.8%. On average, patients were released after 6 days. A univariate analysis showed that possible risk factors for severe medical complications were: low preoperative albumin level, high Charlson Age Comorbidity Index Score and number of days in the intensive care unit (ICU); risk factors for severe surgical complications were: low preoperative albumin level; risk factors for late hospital discharge were: multivisceral resections, number of days in ICU and body mass index (BMI) > 25 kg/m. The multivariate analysis confirmed a low level of preoperative albumin and a longer ICU stay as independent risk factors for both postoperative severe surgical complications and late hospital discharge.
The minimal invasive nature of the laparoscopic approach together with a multimodal analgesia therapy, the early resumption to oral diet and mobilisation could minimize the surgical stress and play an essential role in order to reduce medical morbidity in high-risk patients.
Colorectal surgery within ERAS programme in octogenarians is a safe and flexible treatment in high-volume centres.
术后加速康复（ERAS）如今已被广泛接受为结直肠手术的多模式护理方案，但在应用于非常高龄患者时仍存在一些抵触。
本研究旨在探讨 ERAS 方案下腹腔镜结直肠癌切除术在 80 岁以上患者中的短期疗效。
意大利的一个多中心回顾性数据库在 2008 年至 2017 年期间收集了 162 例年龄≥80 岁接受择期微创结直肠切除术的连续患者数据，这些患者均在 ERAS 方案下接受治疗。进行单变量和多变量分析以评估不良临床结局的可能危险因素。
术后轻微并发症发生率（Clavien-Dindo 1 和 2）为 25.9%。术后主要并发症发生率（定义为 Clavien-Dindo 3 和 4 的严重内科和外科并发症）为 6.1%，吻合口漏仅为 1.8%。再次手术率为 5.5%，围手术期 30 天死亡率为 1.8%，30 天再入院率为 6.8%。平均而言，患者在术后 6 天出院。单变量分析表明，严重内科并发症的可能危险因素包括：术前白蛋白水平低、Charlson 年龄合并症指数评分高和重症监护病房（ICU）住院天数长；严重外科并发症的危险因素为：术前白蛋白水平低；导致延迟出院的危险因素为：多脏器切除术、ICU 住院天数和 BMI（体重指数）>25kg/m。多变量分析证实，术前白蛋白水平低和 ICU 住院时间长是术后严重外科并发症和延迟出院的独立危险因素。
腹腔镜方法的微创性、多模式镇痛治疗、早期恢复口服饮食和活动能力可以最大程度地减少手术应激，对于降低高危患者的内科发病率至关重要。
在高容量中心，ERAS 方案下的 80 岁以上人群结直肠手术是一种安全且灵活的治疗方法。
