Departments of Surgery, Christchurch Hospital, Christchurch, New Zealand.
University of Otago Christchurch, Christchurch, New Zealand.
Colorectal Dis. 2021 Apr;23(4):814-822. doi: 10.1111/codi.15445. Epub 2020 Dec 26.
The primary aim was to compare the 30-day morbidity and mortality in patients aged ≥80 years undergoing surgery for colorectal cancer with those aged <80 years. The secondary aim was to identify independent outcome predictors.
This was a retrospective study of patients undergoing surgery for colorectal cancer between January 2007 and February 2018. Patients were divided into those <80 years and those ≥80 years at the time of surgery. Data had been collected prospectively by the Australasian Binational Colorectal Cancer Audit and included patient demographics, site and stage of tumour, comorbidity, operative details, American Society of Anesthesiologists score (ASA), pathological staging, 30-day mortality and morbidity (medical and surgical). Univariate and multivariate analyses were used to identify predictors of 30-day morbidity and mortality.
During the study period, 4600 out of 20 463 (22.5%) patients were ≥80 years. They had a greater 30-day mortality after both colonic (97/2975 [3.3%] vs. 66/7010 [0.9%], P < 0.001) and rectal resections (50/1625 [3.1%] vs. 36/9006 [0.4%], P < 0.001) compared with younger patients. They also had an increased length of stay (colon cancer, 9 vs. 7 days; rectal cancer, 10 vs. 8 days; P < 0.001) and medical complications (colon cancer, 23.5% vs. 12.7%; rectal cancer, 25.2% vs. 11.2%; P < 0.001). Surgical complications were equivalent. Age ≥80 years was not an independent predictor of 30-day morbidity or mortality. Patients ≥80 years who were ASA 2/3 and had rectal cancer seemed to fare worse in terms of 30-day mortality (ASA 2, 22%, 95% CI 9%-36%, P < 0.001; ASA 3, 11%, 95% CI 4%-19%, P< 0.001).
Postoperative morbidity and mortality are significantly greater in patients ≥80 years undergoing colorectal cancer surgery. Any recommendation for surgery in this age group should take into account patient comorbidity and not be based on age alone.
本研究的主要目的是比较年龄≥80 岁和<80 岁接受结直肠手术的患者的 30 天发病率和死亡率。次要目的是确定独立的预后预测因素。
这是一项回顾性研究，纳入了 2007 年 1 月至 2018 年 2 月期间接受结直肠手术的患者。根据手术时的年龄将患者分为<80 岁和≥80 岁两组。数据由澳大利亚-新西兰结直肠肿瘤联合登记处前瞻性收集，包括患者的人口统计学、肿瘤部位和分期、合并症、手术细节、美国麻醉医师协会（ASA）评分、病理分期、30 天死亡率和发病率（医疗和手术）。采用单因素和多因素分析来确定 30 天发病率和死亡率的预测因素。
在研究期间，20463 例患者中有 4600 例（22.5%）年龄≥80 岁。与年龄较轻的患者相比，他们在结肠（97/2975 [3.3%] 与 66/7010 [0.9%]，P<0.001）和直肠切除术后 30 天的死亡率更高。他们的住院时间也更长（结肠肿瘤，9 天与 7 天；直肠肿瘤，10 天与 8 天；P<0.001），且医疗并发症更多（结肠肿瘤，23.5%与 12.7%；直肠肿瘤，25.2%与 11.2%；P<0.001）。手术并发症则相当。年龄≥80 岁不是 30 天发病率或死亡率的独立预测因素。ASA 2/3 且患有直肠肿瘤的年龄≥80 岁患者在 30 天死亡率方面似乎更差（ASA 2，22%，95%CI 9%-36%，P<0.001；ASA 3，11%，95%CI 4%-19%，P<0.001）。
年龄≥80 岁接受结直肠手术的患者术后发病率和死亡率显著更高。在这个年龄组中进行手术的任何建议都应考虑患者的合并症，而不仅仅是基于年龄。
