Poles Gabriela, Kaur Roma, Ramsdale Erika, Schymura Maria J, Temple Larissa K, Fleming Fergal J, Aquina Christopher T
Department of Surgery, Division of Colorectal Surgery, University of Rochester Medical Center, Rochester, NY.
Surgical Health Outcomes & Research Enterprise, University of Rochester Medical Center, Rochester, NY.
Surgery. 2022 May;171(5):1200-1208. doi: 10.1016/j.surg.2021.10.020. Epub 2021 Nov 24.
Patients ≥85 years of age have high rates of colon cancer but disproportionately poor outcomes. Factors affecting short-term (90-day) survival in patients ≥85 undergoing surgery for stage II and III colon cancer were examined to identify potentially modifiable factors to improve outcomes.
The New York State Cancer Registry and Statewide Planning Research and Cooperative System were queried for patients ≥85 years who underwent colectomy for stage II and III colon cancer between 2004 and 2012. Regression analyses were performed for factors associated with 90-day mortality and stratified by elective and nonelective surgery.
In total, 3,779 patients ≥85 years of age underwent colectomy between 2004 and 2012 for stage II or III colon cancer. Of these, 48.4% underwent nonelective colectomy, 79.9% had an open operation, and 90-day survival was 83.2%. Worse survival was associated with nonelective surgery (odds ratio = 3.81, 95% confidence interval = 3.03-4.89). Improved survival in the nonelective and overall groups was associated with a minimally invasive operation (nonelective group: odds ratio = 0.35, 95% confidence interval = 0.21-0.58; overall group: odds ratio = 0.50, 95% confidence interval = 0.36-0.73) and discharged to another health care facility (nonelective group: odds ratio = 0.30, 95% confidence interval = 0.22-0.39; overall group: odds ratio = 0.42, 95% confidence interval = 0.33-0.53). High surgeon annual operating volume was associated with improved survival in the elective and nonelective groups (P < .001).
Factors associated with greater odds of 90-day mortality in this population include nonelective surgery, preoperative weight loss, and multiple comorbidities, whereas a minimally invasive approach was associated with lower mortality. Potential areas to improve outcomes in this population include using a multidisciplinary team approach, addressing frailty preoperatively when possible, and potentially reconsidering screening guidelines for colorectal cancer to reduce rates of emergency operations.
85岁及以上的患者结肠癌发病率高，但预后却出奇地差。本研究旨在探讨影响85岁及以上II期和III期结肠癌患者手术短期（90天）生存率的因素，以确定可能改善预后的可调节因素。
查询纽约州癌症登记处和全州规划研究与合作系统，获取2004年至2012年间85岁及以上因II期和III期结肠癌接受结肠切除术的患者。对与90天死亡率相关的因素进行回归分析，并按择期手术和非择期手术分层。
2004年至2012年间，共有3779例85岁及以上的患者因II期或III期结肠癌接受了结肠切除术。其中，48.4%接受了非择期结肠切除术，79.9%接受了开放手术，90天生存率为83.2%。较差的生存率与非择期手术相关（比值比=3.81，95%置信区间=3.03-4.89）。非择期手术组和总体组生存率的提高与微创操作相关（非择期手术组：比值比=0.35，95%置信区间=0.21-0.58；总体组：比值比=0.50，95%置信区间=0.36-0.73）以及转至其他医疗机构（非择期手术组：比值比=0.30，95%置信区间=0.22-0.39；总体组：比值比=0.42，95%置信区间=0.33-0.53）。外科医生的年手术量高与择期手术组和非择期手术组生存率的提高相关（P<.001）。
该人群90天死亡率较高的相关因素包括非择期手术、术前体重减轻和多种合并症，而微创方法与较低的死亡率相关。改善该人群预后的潜在领域包括采用多学科团队方法，尽可能在术前解决虚弱问题，并可能重新考虑结直肠癌的筛查指南以降低急诊手术率。
