Cuellar-Gomez Hugo, Rusli Siti Mayuha, Ocharan-Hernández María Esther, Lee Tae-Hoon, Piozzi Guglielmo Niccolò, Kim Seon-Hahn, Vargas-De-León Cruz
Division of Colorectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón SN, Col. Casco de Santo Tomás, Alcaldía Miguel Hidalgo, C. P. 11340, Ciudad de México, Mexico.
J Oncol. 2022 Jan 30;2022:7043380. doi: 10.1155/2022/7043380. eCollection 2022.
Data of all patients ≥75 years who underwent a robotic-assisted curative resection in Korea University Anam Hospital, Seoul, South Korea, between January 2007 and January 2021 were extracted from a prospectively maintained colorectal cancer database. Patients were subdivided into the three groups according to the age: youngest-old (YO: 75-80 years), middle-old (MO: 81-85), and oldest-old (OO: ≥86 years). Intraoperative findings, postoperative, and oncological outcomes were compared between the groups.
Seventy-six consecutive patients (female 52.6%) were included; mean age was 80 years (SD 0.33); mean body mass index (BMI), 23.8 20.9 kg/m (SD 3.58); mean total operative time, 279 min (SD 80.93); mean blood loss, 186 ml (SD 204.03); mean postoperative length of stay, 14 days (SD 12.03). Major complications were seen in 2.1% of patients. The 30-day mortality rate was 0%. Average number of lymph node harvested was 20.9 (SD 12.33). Postoperative complications were not statistically different between the groups. Mean follow-up time for cancer-specific survival (CSS) was 99.28 months for the YO, 72.11 months for MO, and 31.25 months for OO groups ( = 0.045). The CSS rates at 5 years were 27.0%, 21.0%, and 0%, respectively. Recurrence risk was 10.50 times higher in the OO group than the others (adjusted HR, 95% CI 1.868-59.047, = 0.008). In the multivariable analysis, TNM stage was not a risk factor for CSS in all groups. The number of the harvested nodes was a protective factor for recurrence (HR of 0.932, 95% CI 0.875-0.992, = 0.027) and CSS (HR of 0.928, 95% CI 0.861-0.999, = 0.047) in elderly patients.
Robotic surgery is highly feasible in elderly and very elderly colorectal cancer patients, providing a favorable operative safety profile and an acceptable cancer-specific survival outcome.
从韩国首尔延世大学阿岘医院前瞻性维护的结直肠癌数据库中提取2007年1月至2021年1月期间在该院接受机器人辅助根治性切除术的所有75岁及以上患者的数据。根据年龄将患者分为三组：最年轻老年组（YO：75 - 80岁）、中年老年组（MO：81 - 85岁）和最老年组（OO：≥86岁）。比较各组的术中发现、术后情况及肿瘤学结局。
共纳入76例连续患者（女性占52.6%）；平均年龄80岁（标准差0.33）；平均体重指数（BMI）为23.8（标准差3.58）kg/m²；平均总手术时间279分钟（标准差80.93）；平均失血量186毫升（标准差204.03）；平均术后住院时间14天（标准差12.03）。2.1%的患者出现主要并发症。30天死亡率为0%。平均获取淋巴结数为20.9个（标准差12.33）。各组术后并发症无统计学差异。YO组、MO组和OO组癌症特异性生存（CSS）的平均随访时间分别为99.28个月、72.11个月和31.25个月（P = 0.045）。5年CSS率分别为27.0%、21.0%和0%。OO组的复发风险比其他组高10.50倍（校正后风险比，95%置信区间1.868 - 59.047，P = 0.008）。在多变量分析中，TNM分期在所有组中均不是CSS的危险因素。获取的淋巴结数量是老年患者复发（风险比为0.932，95%置信区间0.875 - 0.992，P = 0.027）和CSS（风险比为0.928，95%置信区间0.861 - 0.999，P = 0.047）的保护因素。
机器人手术在老年和高龄结直肠癌患者中具有高度可行性，具有良好的手术安全性和可接受的癌症特异性生存结局。
