Colorectal Surgery Department at Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain. Electronic address: https://twitter.com/DrCarlosCerdan.
General Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
Cir Esp (Engl Ed). 2023 Jun;101(6):426-434. doi: 10.1016/j.cireng.2022.06.026. Epub 2022 Jun 17.
Colon cancer in elderly patients is an increasing problem due to its prevalence and progressive aging population. Prehabilitation has experienced a great grown in this field. Whether it is the best standard of care for these patients has not been elucidated yet.
A retrospective comparative cohort study of three different standards of care for elderly colon cancer patients (>65 years) was conducted. A four-weeks trimodal prehabilitation program (PP), enhanced recovery program (ERP) and conventional care (CC) were compared. Global complications, major complications (Clavien-Dindo ≥ 3), reinterventions, mortality, readmission and length of stay were measured. Optimal recovery, defined as postoperative course without major complications, no mortality, hospital discharge before the fifth postoperative day and without readmission, was the primary outcome measure. The influence of standard of care in optimal recovery and postoperative outcomes was assessed with univariate and multivariate logistic regression models.
A total of 153 patients were included, 51 in each group. Mean age was 77.9 years. ASA Score distribution was different between groups (ASA III-IV: CC 56.9%, ERP 25.5%, PP 58.9%; p = 0.014). Optimal recovery rate was 55.6% (PP 54.9%, ERP 66.7%, CC 45.1%; p = 0.09). No differences were found in major complications (p = 0.2) nor reinterventions (p = 0.7). Uneventful recovery favors ERP and PP groups (p = 0.046 and p = 0.049 respectively).
PP and ERP are safe and effective for older colon cancer patients. Fewer overall complications and readmissions happened in ERP and PP patients. Major complications were independent of the standard of care used.
由于结肠癌的发病率不断增加和人口老龄化的加剧，老年结肠癌患者的问题日益严重。预康复在这一领域得到了广泛的应用。然而，对于这些患者来说，它是否是最佳的护理标准尚未得到阐明。
对三种不同的老年结肠癌患者（>65 岁）护理标准进行了回顾性比较队列研究。比较了四周三模式预康复方案（PP）、加速康复方案（ERP）和常规护理（CC）。测量了总体并发症、主要并发症（Clavien-Dindo ≥ 3）、再次干预、死亡率、再入院率和住院时间。术后无主要并发症、无死亡、术后第 5 天前出院且无再入院的最佳恢复定义为主要观察指标。使用单变量和多变量逻辑回归模型评估护理标准对最佳恢复和术后结果的影响。
共纳入 153 例患者，每组 51 例。平均年龄为 77.9 岁。ASA 评分分布在三组之间存在差异（ASA III-IV：CC 56.9%，ERP 25.5%，PP 58.9%；p=0.014）。最佳恢复率为 55.6%（PP 54.9%，ERP 66.7%，CC 45.1%；p=0.09）。三组间主要并发症发生率无差异（p=0.2），再次干预率也无差异（p=0.7）。无并发症恢复在 ERP 和 PP 组中更为常见（p=0.046 和 p=0.049）。
PP 和 ERP 对老年结肠癌患者是安全有效的。ERP 和 PP 组的总并发症和再入院率较低。主要并发症与所使用的护理标准无关。
