Department of General Surgery, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Department of Anesthesiology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
World J Surg Oncol. 2020 Jun 3;18(1):120. doi: 10.1186/s12957-020-01895-8.
Advanced age is a risk factor for colorectal cancer, and very elderly patients often need to be surgically treated. This study aimed to analyze the outcomes of a cohort of nonagenarian patients operated on for colorectal cancer.
Observational study conducted on a cohort of 40 nonagenarian patients, who were treated surgically for colorectal cancer between 2000 and 2018 in our institution. Clinical data, ASA score, Charlson Comorbidity Index, Surgical Mortality Probability Model, tumor characteristics, and nature and technical features of the surgical procedure, were recorded. The Comprehensive Complication Index (CCI) and survival time after the procedure were recorded as outcome variables. Univariate and multivariate analyses were performed in order to define risk factors for postoperative complications and long-term survival.
Out of the 40 patients, 13 (32.5%) were men, 27 (67.5%) women, and mean age 91.6 years (SD ± 1.5). In 24 patients (60%), surgery was elective, and in 16 patients (40%), surgery was emergent. Curative surgery with intestinal resection was performed in 34 patients (85%). In 22 patients (55%), intestinal continuity was restored by performing an anastomosis. The median CCI was 22.6 (IRQ 0.0-42.6). Operative mortality was 10% (4 patients). Cumulative survival at 1, 3, and 5 years was 70%, 47%, and 29%, respectively. In multivariate analysis, only the need for transfusion remained as an independent prognostic factor for complications (p = 0.021) and TNM tumor stage as a significant predictor of survival (HR 3.0, CI95% 1.3-7.2).
Colorectal cancer surgery is relatively safe in selected nonagenarian patients and may achieve long-term survival.
高龄是结直肠癌的一个危险因素，许多非常高龄的患者需要接受手术治疗。本研究旨在分析一组接受结直肠癌手术的 90 岁以上患者的治疗效果。
本研究为观察性研究，纳入了 2000 年至 2018 年期间在我院接受手术治疗的 40 例 90 岁以上结直肠癌患者。记录了临床数据、ASA 评分、Charlson 合并症指数、手术死亡率预测模型、肿瘤特征以及手术的性质和技术特点。综合并发症指数（CCI）和手术后的生存时间被记录为结果变量。进行了单变量和多变量分析，以确定术后并发症和长期生存的危险因素。
40 例患者中，13 例（32.5%）为男性，27 例（67.5%）为女性，平均年龄 91.6 岁（标准差±1.5）。24 例（60%）患者为择期手术，16 例（40%）为急诊手术。34 例（85%）患者行肠道切除术。22 例（55%）患者行吻合术恢复肠道连续性。CCI 的中位数为 22.6（四分位距 0.0-42.6）。手术死亡率为 10%（4 例）。1、3、5 年累积生存率分别为 70%、47%和 29%。多变量分析显示，仅输血需求是并发症的独立预后因素（p=0.021），TNM 肿瘤分期是生存的显著预测因素（HR 3.0，95%CI 1.3-7.2）。
在选择合适的 90 岁以上患者中，结直肠癌手术相对安全，可获得长期生存。
