Yang In Jun, Oh Heung-Kwon, Lee Jeehye, Suh Jung Wook, Ahn Hong-Min, Shin Hye Rim, Kim Jin Won, Kim Jee Hyun, Song Changhoon, Choi Jung-Yeon, Kim Duck-Woo, Kang Sung-Bum
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Ann Surg Treat Res. 2022 Sep;103(3):169-175. doi: 10.4174/astr.2022.103.3.169. Epub 2022 Sep 6.
Multidisciplinary care has become a cornerstone of colorectal cancer management. To evaluate the clinical efficacy of a geriatric multidisciplinary oncology clinic (GMOC), we analyzed the surgical treatment decision-making process and outcomes.
This retrospective single-center study reviewed the data of patients aged ≥65 years who participated in the GMOC at a tertiary referral hospital between 2015 and 2021. The clinical adherence rate, comprehensive geriatric assessment, and a multidimensional frailty score (MFS) were obtained. The groups that were recommended and not recommended for surgery were compared, analyzing the factors impacting the decision and 1-year survival outcomes. Furthermore, the postoperative complications of patients who underwent surgery were evaluated.
A total of 165 patients visited the GMOC, and 74 had colorectal cancer (mean age, 85.5 years [range, 81.2-89.0 years]). Among patients with systemic disease (n = 31), 7 were recommended for surgery, and 5 underwent surgery. Among patients with locoregional disease (n = 43), 18 were recommended for surgery, and 12 underwent surgery. Patients recommended and not recommended for surgery had significantly different activities of daily living (ADL) (P = 0.024), instrumental ADL (P = 0.001), Mini-Mental State Examination (P = 0.014), delirium risk (P = 0.039), and MFS (P = 0.001). There was no difference in the 1-year overall survival between the 2 groups (P = 0.980). Of the 17 patients who underwent surgery, the median (interquartile range) of operation time was 165.0 minutes (120.0-270.0 minutes); hospital stay, 7.0 days (6.0-8.0 days); and 3 patients had wound complications.
Proper counseling of patients through the GMOC could lead to appropriate management and favorable outcomes.
多学科护理已成为结直肠癌管理的基石。为评估老年多学科肿瘤门诊（GMOC）的临床疗效，我们分析了手术治疗决策过程及结果。
这项回顾性单中心研究回顾了2015年至2021年间在一家三级转诊医院参加GMOC的65岁及以上患者的数据。获取临床依从率、综合老年评估和多维衰弱评分（MFS）。比较建议手术和不建议手术的两组患者，分析影响决策的因素及1年生存结果。此外，评估接受手术患者的术后并发症。
共有165名患者就诊于GMOC，其中74例患有结直肠癌（平均年龄85.5岁[范围81.2 - 89.0岁]）。在患有全身性疾病的患者（n = 31）中，7例被建议手术，5例接受了手术。在患有局部区域性疾病的患者（n = 43）中，18例被建议手术，12例接受了手术。建议手术和不建议手术的患者在日常生活活动能力（ADL）（P = 0.024）、工具性ADL（P = 0.001）、简易精神状态检查表（P = 0.014）、谵妄风险（P = 0.039）和MFS（P = 0.001）方面存在显著差异。两组患者的1年总生存率无差异（P = 0.980）。在接受手术的17例患者中，手术时间的中位数（四分位间距）为165.0分钟（120.0 - 270.0分钟）；住院时间为7.0天（6.0 - 8.0天）；3例患者出现伤口并发症。
通过GMOC对患者进行适当的咨询可导致恰当的管理并取得良好的结果。
