Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
Department of Surgery, Tays Hatanpää, P.O. Box 2000, 33521, Tampere, Finland.
Int J Colorectal Dis. 2020 Feb;35(2):307-315. doi: 10.1007/s00384-019-03488-8. Epub 2019 Dec 18.
Patients aged > 80 years represent an increasing proportion of colon cancer diagnoses. Selecting patients for elective surgery is challenging because of possibly compromised health status and functional decline. The aim of this retrospective, population-based study was to identify risk factors and health measures that predict short-term mortality after elective colon cancer surgery in the aged.
All patients > 80 years operated electively for stages I-III colon cancer from 2005 to 2016 in four Finnish hospitals were included. The prospectively collected data included comorbidities, functional status, postoperative surgical and medical outcomes as well as mortality data.
A total of 386 patients (mean 84.0 years, range 80-96, 56% female) were included. Male gender (46% vs 35%, p = 0.03), higher BMI (51% vs 37%, p = 0.02), diabetes mellitus (51% vs 37%, p = 0.02), coronary artery disease (52% vs 36%, p = 0.003) and rheumatic diseases (67% vs 39%, p = 0.03) were related to higher risk of complications. The severe complications were more common in patients with increased preoperative hospitalizations (31% vs 15%, p = 0.05) and who lived in nursing homes (30% vs 17%, p = 0.05). The 30-day and 1-year mortality rates were 6.0% and 15% for all the patients compared with 30% and 45% in patients with severe postoperative complications (p < 0.001). Severe postoperative complications were the only significant patient-related variable affecting 1-year mortality (OR 9.60, 95% CI 2.33-39.55, p = 0.002).
The ability to identify preoperatively patients at high risk of decreased survival and thus prevent severe postoperative complications could improve overall outcome of aged colon cancer patients.
80 岁以上的患者在结肠癌诊断中所占比例不断增加。由于健康状况可能受损和功能下降，选择接受择期手术的患者具有挑战性。本回顾性、基于人群的研究旨在确定预测高龄患者择期结肠癌手术后短期死亡率的风险因素和健康指标。
纳入 2005 年至 2016 年间在芬兰的四家医院接受择期 I-III 期结肠癌手术的所有 80 岁以上患者。前瞻性收集的数据包括合并症、功能状态、术后手术和医疗结果以及死亡率数据。
共纳入 386 例患者（平均 84.0 岁，范围 80-96 岁，56%为女性）。男性（46%比 35%，p=0.03）、更高的 BMI（51%比 37%，p=0.02）、糖尿病（51%比 37%，p=0.02）、冠状动脉疾病（52%比 36%，p=0.003）和风湿性疾病（67%比 39%，p=0.03）与并发症风险增加相关。术前住院次数增加（31%比 15%，p=0.05）和居住在养老院的患者（30%比 17%，p=0.05）更易发生严重并发症。所有患者的 30 天和 1 年死亡率分别为 6.0%和 15%，而严重术后并发症患者分别为 30%和 45%（p<0.001）。严重术后并发症是唯一影响 1 年死亡率的显著患者相关变量（OR 9.60，95%CI 2.33-39.55，p=0.002）。
术前识别生存可能性降低的高危患者，并预防严重术后并发症，可能会改善高龄结肠癌患者的总体预后。
