Turri Giulia, Caliskan Gulser, Conti Cristian, Martinelli Luigi, De Giulio Ernesto, Ruzzenente Andrea, Guglielmi Alfredo, Verlato Giuseppe, Pedrazzani Corrado
Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
Front Oncol. 2022 Oct 21;12:959650. doi: 10.3389/fonc.2022.959650. eCollection 2022.
As the world population is progressively ageing, more and more elderly patients will require cancer surgery. Although curative surgery is the treatment of choice for resectable colorectal cancer (CRC), it is still debated whether elderly frail patients should undergo major cancer surgery due to the increased risk of postoperative and long-term mortality. The aim of this retrospective study was to evaluate the impact of age and comorbidities on postoperative mortality/morbidity and long-term outcomes, looking for potential age-related survival differences.
A total of 1,482 patients operated for CRC at our institution between January 2005 and October 2020 were analysed. The independent effect of age and comorbidities on postoperative complications was assessed by a logistic model, while the effect on overall survival (OS) and cancer-related survival (CRS) was estimated by a Cox regression model.
The median age in the cohort was 67.8 years. Postoperative mortality was very low in the whole cohort (0.8%) and contained even in older age groups (3.2% in patients aged 80-84 years, 4% in the 85-90-year age group). The cumulative incidence of postoperative complications was doubled in patients with comorbidities (32.8% vs. 15.1%, p = 0.002). With regard to OS, as expected, it exponentially decreased with advancing age. Conversely, differences in CRS were less pronounced between age groups and absent in patients with stage 0-I CRC. Analysis of all causes and cancer-related mortality revealed a peak within 2 years from surgery, suggesting a prolonged impact of surgery. In patients aged 75 years and above, all-cause mortality showed a steep increase 1 year after surgery, while cancer-related mortality plateaued at about 4 years after surgery. On multivariable analysis, OS, but not CRS, was significantly influenced by age.
Although acceptable results of surgery in elderly patients, OS is strongly dependent on age: older people die more from competing causes than cancer-related treatments compared to younger age classes. The preoperative identification of risk factors for low OS may help the selection of those elderly patients who would benefit from curative CRC surgery.
随着世界人口逐渐老龄化，越来越多的老年患者需要进行癌症手术。尽管根治性手术是可切除结直肠癌（CRC）的首选治疗方法，但老年体弱患者由于术后和长期死亡率增加，是否应接受大型癌症手术仍存在争议。这项回顾性研究的目的是评估年龄和合并症对术后死亡率/发病率以及长期结局的影响，寻找潜在的与年龄相关的生存差异。
对2005年1月至2020年10月期间在我们机构接受CRC手术的1482例患者进行分析。通过逻辑模型评估年龄和合并症对术后并发症的独立影响，而通过Cox回归模型估计对总生存期（OS）和癌症相关生存期（CRS）的影响。
该队列的中位年龄为67.8岁。整个队列的术后死亡率非常低（0.8%），甚至在老年组中也较低（80-84岁患者中为3.2%，85-90岁年龄组中为4%）。合并症患者术后并发症的累积发生率增加了一倍（32.8%对15.1%，p = 0.002）。关于OS，正如预期的那样，它随着年龄的增长呈指数下降。相反，CRS在各年龄组之间的差异不太明显，在0-I期CRC患者中不存在差异。对所有原因和癌症相关死亡率的分析显示，术后2年内有一个峰值，表明手术的影响持续时间较长。在75岁及以上的患者中，全因死亡率在术后1年急剧上升，而癌症相关死亡率在术后约4年趋于平稳。在多变量分析中，OS受年龄显著影响，而CRS不受影响。
尽管老年患者手术结果可接受，但OS强烈依赖于年龄：与年轻患者相比，老年人死于竞争原因的情况比死于癌症相关治疗的情况更多。术前识别低OS的危险因素可能有助于选择那些将从根治性CRC手术中获益的老年患者。
