Kondo Akihiro, Okano Keiichi, Kumamoto Kensuke, Kobara Hideki, Nagahara Teruya, Wato Masaki, Shibatoge Mitsushige, Minato Takuya, Masaki Tsutomu, Suzuki Yasuyuki
Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Surgery. 2022 Jul;172(1):60-68. doi: 10.1016/j.surg.2021.12.007. Epub 2022 Jan 5.
The outcomes and prognostic factors of elderly patients with obstructive colorectal cancer are unknown. This was the focus of our multi-institutional retrospective study.
Medical records of 520 patients (elderly [group E, aged ≥75 years, n = 271]; and nonelderly [group NE, aged <75 years, n = 249]) who received treatment for obstructive colorectal cancer in 2008 to 2018 at 14 leading hospitals in Kagawa prefecture (Japan) were reviewed. Short- and long-term outcomes of patients who underwent tumor resection (n = 438) were compared between the groups. Their prognostic factors were identified.
The tumor resection rate was 79% (n = 213) and 90% (n = 225) in groups E and NE, respectively. Group E had more emergency resections (27 [12.7%] vs 15 [6.6%], P = .037), shorter operating times (194 vs 221 min, P < .001), fewer dissected lymph nodes (14 vs 17, P = .004), and less adjuvant chemotherapy (47 [26.8%] vs 122 [76.7%], p < .001) than group NE. Postoperative complication rates and recurrence-free survival were not significantly different between the groups. Overall survival was significantly lower in group E than in group NE. Distant metastases and no postoperative chemotherapy were independent poor prognostic factors for overall survival in groups E and NE. Emergency resection (hazard ratio:1.83; 95% confidence interval: 1.02-3.26) was a significant poor prognostic indicator in group E only.
The short-term outcomes and recurrence-free survival of elderly and nonelderly patients with obstructive colorectal cancer were similar, although the 90-day mortality rate of the elderly patients was higher. Furthermore, elective surgery after bowel decompression is associated with a better outcome in the elderly.
老年梗阻性结直肠癌患者的治疗结果及预后因素尚不清楚。这是我们多机构回顾性研究的重点。
回顾了2008年至2018年在日本香川县14家主要医院接受梗阻性结直肠癌治疗的520例患者的病历（老年组[E组，年龄≥75岁，n = 271]；非老年组[NE组，年龄<75岁，n = 249]）。比较了接受肿瘤切除的患者（n = 438）的短期和长期治疗结果。确定了他们的预后因素。
E组和NE组的肿瘤切除率分别为79%（n = 213）和90%（n = 225）。E组的急诊手术更多（27例[12.7%]对15例[6.6%]，P = .037），手术时间更短（194分钟对221分钟，P < .001），清扫淋巴结更少（14个对17个，P = .004），辅助化疗更少（47例[26.8%]对122例[76.7%]，p < .001）。两组术后并发症发生率和无复发生存率无显著差异。E组的总生存率显著低于NE组。远处转移和未进行术后化疗是E组和NE组总生存的独立不良预后因素。急诊手术（风险比：1.83；95%置信区间：1.02 - 3.26）仅是E组的显著不良预后指标。
老年和非老年梗阻性结直肠癌患者的短期治疗结果和无复发生存率相似，尽管老年患者的90天死亡率更高。此外，肠道减压后择期手术对老年患者的预后更好。
