80岁及以上胃癌患者行胃切除术是否安全?一项荟萃分析和系统评价
Is it safe to perform gastrectomy in gastric cancer patients aged 80 or older?: A meta-analysis and systematic review.
作者信息
Xu Yixin, Wang Yibo, Xi Cheng, Ye Nianyuan, Xu Xuezhong
机构信息
Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou, Jiangsu Province, China.
出版信息
Medicine (Baltimore). 2019 Jun;98(24):e16092. doi: 10.1097/MD.0000000000016092.
BACKGROUND
Few studies have focused on octogenarian patients with gastric cancer (GC) who have undergone gastrectomy. This meta-analysis of published studies was performed to assess the safety of treating octogenarian GC patients with surgery.
METHODS
Databases, including PubMed, Embase, Web of Science, and Cochrane Library were searched until January 2019. The incidence of preoperative comorbidities, postoperative complications, and mortality was assessed using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Further, the hazard ratios (HRs) with 95% CIs were applied for survival outcomes.
RESULTS
A total of 18,179 patients with GC in 21 studies were included. Our results demonstrated that octogenarian patients were associated with a higher burden of comorbidities (OR = 2.79; 95% CI: 2.37, 3.28; P = .00), high incidences of overall postoperative complications (OR = 1.48; 95% CI: 1.22, 1.81; P = .00), medical postoperative complications (OR = 2.58; 95% CI: 1.91, 3.49; P = .00), in-hospital mortality (OR = 3.24; 95% CI: 2.43, 4.31; P = .00) and poor overall survival (HR = 1.96; 95% CI: 1.65, 2.27; P = .00).
CONCLUSIONS
Considering the high burden of comorbidities, high incidences of postoperative complications and mortality, surgery for extremely elderly patients with GC requires deliberation. Individualized treatment is recommended for such patients.
背景
很少有研究关注接受胃切除术的老年胃癌(GC)患者。本荟萃分析已发表的研究,以评估手术治疗老年GC患者的安全性。
方法
检索包括PubMed、Embase、Web of Science和Cochrane图书馆在内的数据库,直至2019年1月。使用比值比(OR)及相应的95%置信区间(CI)评估术前合并症、术后并发症和死亡率的发生率。此外,生存结局采用95%CI的风险比(HR)。
结果
21项研究共纳入18179例GC患者。我们的结果表明,老年患者合并症负担更高(OR = 2.79;95%CI:2.37,3.28;P = 0.00),术后总体并发症发生率高(OR = 1.48;95%CI:1.22,1.81;P = 0.00),术后医疗并发症发生率高(OR = 2.58;95%CI:1.91,3.49;P = 0.00),住院死亡率高(OR = 3.24;95%CI:2.43,4.31;P = 0.00),总体生存率差(HR = 1.96;95%CI:1.65,2.27;P = 0.00)。
结论
考虑到合并症负担高、术后并发症和死亡率高,老年GC患者的手术需要慎重考虑。建议对此类患者进行个体化治疗。
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