Unidad de Cirugía Coloproctológica, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
Unidad de Cirugía Coloproctológica, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
Cir Esp (Engl Ed). 2020 Aug-Sep;98(7):389-394. doi: 10.1016/j.ciresp.2020.01.004. Epub 2020 Feb 22.
Frailty is associated with greater postoperative morbidity and mortality. Individualized multidisciplinary management of these patients can improve the quality of care. The objectives of this study are to determine the percentage of frail patients with colorectal cancer in our population, and to describe the morbidity and mortality associated with surgery and the evolution of palliative treatment.
A prospective, observational study of patients with surgical colorectal cancer (February 1, 2018-April 30, 2019). Frail patients were screened and classified according to degrees of frailty. Therapeutic decision-making (surgery or palliative treatment) was determined by the degree of fragility and explicit will of the patient. Postoperative comorbidities were analyzed (according to Clavien-Dindo and Comprehensive Complication Index), as were mortality and oncological follow-up.
The study included 193 patients with surgical colorectal cancer, with a mean age of 74 years (44-92). Screening identified 46 frail patients (24%), with a mean age of 80 years (57-92). Twenty-two patients were optimized and underwent surgery (48%), with a mean age of 78 years (57-89). Relevant adverse effect rate was 27.7% (4 grade iva adverse effects, one ivb and one v, according to Clavien-Dindo). Comprehensive Complication Index was 17.5. Palliative treatment was administered in 24 patients (52%), with a mean age of 82 years (59-92). Mean follow-up was 7.8 months. There were 2 deaths due to disease progression (8.3%), 5 re-consultations due to complications of colorectal cancer (20.1%).
The multidisciplinary and individualized management of frail patients with colorectal cancer is key to improve the quality of care in the treatment of this patient group.
衰弱与更高的术后发病率和死亡率相关。对这些患者进行个体化的多学科管理可以提高护理质量。本研究的目的是确定我们人群中患有结直肠癌的虚弱患者的百分比，并描述与手术相关的发病率和死亡率以及姑息治疗的演变。
对 2018 年 2 月 1 日至 2019 年 4 月 30 日期间接受结直肠手术的患者进行前瞻性、观察性研究。对虚弱患者进行筛选并根据虚弱程度进行分类。治疗决策（手术或姑息治疗）由虚弱程度和患者的明确意愿决定。分析了术后合并症（根据 Clavien-Dindo 和综合并发症指数），以及死亡率和肿瘤学随访。
研究纳入了 193 例接受结直肠手术的患者，平均年龄为 74 岁（44-92 岁）。筛查发现 46 例虚弱患者（24%），平均年龄为 80 岁（57-92 岁）。22 例患者经过优化后接受了手术（48%），平均年龄为 78 岁（57-89 岁）。相关不良事件发生率为 27.7%（4 级 iva 不良事件，1 级 ivb 和 1 级 v，根据 Clavien-Dindo）。综合并发症指数为 17.5。24 例患者接受了姑息治疗（52%），平均年龄为 82 岁（59-92 岁）。平均随访时间为 7.8 个月。因疾病进展导致 2 例死亡（8.3%），因结直肠癌并发症导致 5 例再次就诊（20.1%）。
对患有结直肠癌的虚弱患者进行多学科和个体化管理是改善该患者群体治疗质量的关键。
