Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
Faculty of Social Sciences, Tampere University, Tampere, Finland.
Colorectal Dis. 2021 Jul;23(7):1824-1836. doi: 10.1111/codi.15689. Epub 2021 May 15.
Identification of the risks of postoperative complications may be challenging in older patients with heterogeneous physical and cognitive status. The aim of this multicentre, observational study was to identify variables that affect the outcomes of colon cancer surgery and, especially, to find tools to quantify the risks related to surgery.
Patients aged ≥80 years with electively operated Stage I-III colon cancer were recruited. The prospectively collected data included comorbidities, results of the onco-geriatric screening tool (G8), Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and Mini Nutritional Assessment-Short Form (MNA-SF), and operative and postoperative outcomes.
A total of 161 patients (mean 84.5 years, range 80-97, 60% female) were included. History of cerebral stroke (64% vs. 37%, p = 0.02), albumin level 31-34 g/l compared with ≥35 g/l (57% vs. 32%, p = 0.007), CFS 3-4 and 5-9 compared with CFS 1-2 (49% and 47% vs. 16%, respectively) and American Society of Anesthesiologists score >3 (77% vs. 28%, P = 0.006) were related to a higher risk of complications. In multivariate logistic regression analysis CFS ≥3 (OR 6.06, 95% CI 1.88-19.5, p = 0.003) and albumin level 31-34 g/l (OR 3.88, 1.61-9.38, p = 0.003) were significantly associated with postoperative complications. Severe complications were more common in patients with chronic obstructive pulmonary disease (43% vs. 13%, p = 0.047), renal failure (25% vs. 12%, p = 0.021), albumin level 31-34 g/l (26% vs. 8%, p = 0.014) and CCI >6 (23% vs. 10%, p = 0.034).
Surgery on physically and cognitively fit aged colon cancer patients with CFS 1-2 can lead to excellent operative outcomes similar to those of younger patients. The CFS could be a useful screening tool for predicting postoperative complications.
对于身体和认知状态存在异质性的老年患者，识别术后并发症的风险可能具有挑战性。本多中心观察性研究的目的是确定影响结肠癌手术结果的变量，特别是寻找量化与手术相关风险的工具。
招募择期接受 I-III 期结肠癌手术的年龄≥80 岁的患者。前瞻性收集的数据包括合并症、肿瘤老年综合评估工具（G8）、临床虚弱量表（CFS）、Charlson 合并症指数（CCI）和迷你营养评估-简短表格（MNA-SF）的结果，以及手术和术后结果。
共纳入 161 例患者（平均 84.5 岁，范围 80-97 岁，60%为女性）。与 37%的患者相比，有脑卒中病史的患者比例为 64%（p=0.02），白蛋白水平为 31-34g/L 而非≥35g/L 的患者比例为 57%（p=0.007），与 CFS 1-2 相比，CFS 3-4 和 5-9 的患者比例分别为 49%和 47%（分别为 16%），美国麻醉医师协会评分>3 的患者比例为 77%（p=0.006）。与并发症风险较高相关。在多变量逻辑回归分析中，CFS≥3（OR 6.06，95%CI 1.88-19.5，p=0.003）和白蛋白水平 31-34g/L（OR 3.88，1.61-9.38，p=0.003）与术后并发症显著相关。慢性阻塞性肺疾病（43% vs. 13%，p=0.047）、肾衰竭（25% vs. 12%，p=0.021）、白蛋白水平 31-34g/L（26% vs. 8%，p=0.014）和 CCI>6（23% vs. 10%，p=0.034）的患者更常见严重并发症。
对于身体和认知状态良好的 CFS 1-2 年龄组的结肠癌患者进行手术可带来与年轻患者相似的出色手术结果。CFS 可能是预测术后并发症的有用筛查工具。
