Franklyn J, Abdalkoddus M, Rossi B, Limnatitou D, Ahmed M, Sokker A, Douie W J, Smolarek S
University Hospitals Plymouth NHS Trust, Plymouth, UK.
Ann R Coll Surg Engl. 2020 Sep;102(7):504-509. doi: 10.1308/rcsann.2020.0067. Epub 2020 Aug 17.
The aim of the study was to establish the natural history of elderly patients with non-metastatic colorectal cancer who underwent non-operative management in comparison with those who underwent operative management.
A retrospective analysis of patients aged 80 years and above diagnosed with colorectal cancer between 2007 and 2015 in a tertiary care hospital in the Southwest of England was done. Patients were divided into non-operatively managed and operatively managed groups. Clinical demographics, Charlson Comorbidity Index, location of the tumour and overall survival between the two groups were compared.
A total of 407 patients were studied; 132 were treated non-operatively and 275 operatively. The non-operative group included fewer right-sided colon cancers (28.7% vs 54.9%), but significantly more rectal cancers were managed non-operatively (43.9 vs 23.6%, respectively). The two and five year overall survival was 38.9% and 11.3% respectively in the non-operative group, significantly lower than patients in the operative group where the two and five year survival was 78.9% and 59.6% respectively ( = .0001). The median Charlson Comorbidity Index was 7.99 for the non-operative group and 7.49 in the operative group ( = 0.109). Patients treated non-operatively were deemed unfit without objective frailty assessment and only 43/132(32.6%) had formal anaesthetic assessment before being deemed unfit for surgery.
The survival of octa- and nonagenarians with non-metastatic colorectal cancer managed conservatively is significantly less than counterparts managed operatively. Our present strategy of deciding and denying treatment of the elderly patient with colorectal cancer is arbitrary, highlighting the need for robust geriatric and frailty assessment.
本研究的目的是确定接受非手术治疗的老年非转移性结直肠癌患者与接受手术治疗的患者相比的自然病程。
对2007年至2015年在英格兰西南部一家三级护理医院诊断为结直肠癌的80岁及以上患者进行回顾性分析。患者分为非手术治疗组和手术治疗组。比较两组的临床人口统计学、Charlson合并症指数、肿瘤位置和总生存率。
共研究了407例患者；132例接受非手术治疗，275例接受手术治疗。非手术治疗组右侧结肠癌较少（28.7%对54.9%），但非手术治疗的直肠癌明显更多（分别为43.9%对23.6%）。非手术治疗组的两年和五年总生存率分别为38.9%和11.3%，显著低于手术治疗组，手术治疗组的两年和五年生存率分别为78.9%和59.6%（P = .0001）。非手术治疗组的Charlson合并症指数中位数为7.99，手术治疗组为7.49（P = 0.109）。未经客观虚弱评估，非手术治疗的患者被认为不适合手术，只有43/132（32.6%）在被认为不适合手术前进行了正式的麻醉评估。
保守治疗的八旬和九旬非转移性结直肠癌患者的生存率明显低于手术治疗的患者。我们目前决定和拒绝老年结直肠癌患者治疗的策略是任意的，这突出了进行全面的老年医学和虚弱评估的必要性。
