术前综合老年评估可预测老年食管癌患者的术后风险。

Preoperative Comprehensive Geriatric Assessment Predicts Postoperative Risk in Older Patients with Esophageal Cancer.

作者信息

Yamashita Kotaro, Yamasaki Makoto, Makino Tomoki, Tanaka Koji, Saito Takuro, Yamamoto Kazuyoshi, Takahashi Tsuyoshi, Kurokawa Yukinori, Yasunobe Yukiko, Akasaka Hiroshi, Rakugi Hiromi, Nakajima Kiyokazu, Eguchi Hidetoshi, Doki Yuichiro

机构信息

Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.

Department of Surgery, Kansai Medical University, Osaka, Japan.

出版信息

Ann Surg Oncol. 2023 Feb;30(2):901-909. doi: 10.1245/s10434-022-12778-5. Epub 2022 Nov 11.

DOI:10.1245/s10434-022-12778-5

PMID:36367627

Abstract

BACKGROUND

Preoperative risk assessment is important in older patients because they often have comorbidities and impaired organ function. We performed preoperative comprehensive geriatric assessment (CGA) for older patients with esophageal cancer.

PATIENTS AND METHODS

A total of 217 patients over 75 years old who underwent esophagectomy for thoracic esophageal cancer were analyzed. The CGA was performed preoperatively and included the Mini-Mental State Examination (MMSE), Geriatric Depression Score (GDS), vitality index, Barthel index, and instrumental activities of daily living (IADL). We defined the robust group as patients with normal function on every instrument, and the pre-frail and frail groups as those with functional impairment on one instrument or two or more instruments, respectively. We assessed how the CGA correlated with postoperative complications and prognosis.

RESULTS

Of the 217 patients, 86 (39.6%) were in the robust group, 68 (31.3%) in the pre-frail group, and 63 (29.0%) in the frail group. Postoperative pneumonia (P = 0.026) and anastomotic leakage (P = 0.032) were significantly more common in the frail group. The frail group had a significantly longer postoperative hospitalization period (P = 0.016) and significantly lower rate of discharge to home (P = 0.016). Overall survival (OS) was significantly worse in the frail group (5-year overall survival rate, frail group versus others, 37.8% versus 52.0%, P = 0.046), but it was not significant on multivariate analysis.

CONCLUSIONS

The preoperative CGA in older patients with esophageal cancer was associated with risk of postoperative complications.

摘要

背景

术前风险评估对老年患者很重要，因为他们常伴有合并症且器官功能受损。我们对老年食管癌患者进行了术前综合老年评估（CGA）。

患者与方法

分析了217例75岁以上接受胸段食管癌食管切除术的患者。术前进行CGA，包括简易精神状态检查表（MMSE）、老年抑郁量表（GDS）、活力指数、巴氏指数和日常生活活动能力量表（IADL）。我们将功能正常组定义为各项检查功能均正常的患者，将衰弱前期组和衰弱组分别定义为在一项检查或两项及以上检查中存在功能障碍的患者。我们评估了CGA与术后并发症及预后的相关性。

结果

217例患者中，86例（39.6%）为功能正常组，68例（31.3%）为衰弱前期组，63例（29.0%）为衰弱组。衰弱组术后肺炎（P = 0.026）和吻合口漏（P = 0.032）明显更常见。衰弱组术后住院时间明显更长（P = 0.016），出院回家率明显更低（P = 0.016）。衰弱组的总生存期（OS）明显更差（5年总生存率，衰弱组与其他组相比，37.8%对52.0%，P = 0.046），但多因素分析时无显著性差异。