右侧结肠癌急诊手术干预的结果：基于丹麦结直肠癌组登记的全国性基于人群的研究。

Outcomes of emergency surgical interventions in right-sided colonic cancer: nationwide population-based study based on Danish Colorectal Cancer Group register.

机构信息

Department of Surgery, OpenSource Research Collaboration, Aalborg, Denmark.

Department of Epidemiology, Aalborg University Hospital, Aalborg, Denmark.

出版信息

BJS Open. 2023 Jan 6;7(1). doi: 10.1093/bjsopen/zrac153.

DOI:10.1093/bjsopen/zrac153

PMID:36802245

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9942550/

Abstract

AIM

The aim of this study was to investigate the trends in morbidity and mortality of patients with right-sided colonic cancer who had an emergency surgical procedure in Denmark after the introduction of quality index parameters.

METHODS

This was a retrospective nationwide study based on a prospectively maintained Danish Colorectal Cancer Group database focused on right-sided colonic cancer in the interval from 1 May 2001 to 30 April 2018, who underwent emergency surgical intervention (within 48 h of hospital admission). The primary objective was to investigate the trends in morbidity and mortality throughout the study years. Multivariable estimates were adjusted for age, sex, smoking status, alcohol consumption, ASA score classification, tumour localization, type of access to abdominal cavity, surgeon's grade of specialization, and metastatic disease.

RESULTS

Out of 2839 patients, a total of 2740 patients fulfilled the inclusion criteria, of whom 2464 underwent right or transverse colon resection (89.9 per cent). The 30-day and 90-day postoperative mortality rates were significantly reduced over the time of the study (OR 0.943, 95 per cent c.i. 0.922 to 0.965, P < 0.001 and OR 0.953, 95 per cent c.i. 0.934 to 0.972, P < 0.001 respectively); however, the complication rates did not follow this trend. Older patients (OR 1.032, 95 per cent c.i. 1.009 to 1.055, P = 0.005) and patients with high ASA scores (OR 1.61, 95 per cent c.i. 1.422 to 1.830, P < 0.001) had higher rates of severe grade 3b postoperative complications. A stoma was constructed in 276 patients (10 per cent), whereas a stent was used in only eight patients. Defunctioning procedures, including stoma construction or colonic stenting (without oncological resection), did not reduce the risk of complications compared with that of definitive surgery.

CONCLUSION

The 30-day and 90-day postoperative mortality rates were significantly reduced over the time of the study. Age and ASA score were risk factors for severe postoperative complications.

摘要

目的

本研究旨在调查丹麦在引入质量指数参数后，接受急诊手术的右侧结肠癌患者的发病率和死亡率趋势。

方法

这是一项基于前瞻性维持的丹麦结直肠癌组数据库的全国性回顾性研究，重点关注 2001 年 5 月 1 日至 2018 年 4 月 30 日期间接受急诊手术干预（入院后 48 小时内）的右侧结肠癌患者。主要目的是调查研究期间发病率和死亡率的趋势。多变量估计值根据年龄、性别、吸烟状况、饮酒、ASA 评分分类、肿瘤定位、进入腹腔的方式、外科医生的专业水平和转移性疾病进行调整。

结果

在 2839 名患者中，共有 2740 名患者符合纳入标准，其中 2464 名患者接受了右半结肠或横结肠切除术（89.9%）。研究期间，30 天和 90 天术后死亡率显著降低（OR 0.943，95%可信区间 0.922 至 0.965，P<0.001 和 OR 0.953，95%可信区间 0.934 至 0.972，P<0.001）；然而，并发症发生率并未遵循这一趋势。年龄较大的患者（OR 1.032，95%可信区间 1.009 至 1.055，P=0.005）和 ASA 评分较高的患者（OR 1.61，95%可信区间 1.422 至 1.830，P<0.001）术后严重 3b 级并发症发生率较高。276 名患者（10%）接受了造口术，而仅 8 名患者使用了支架。与确定性手术相比，预防性造口术或结肠支架置入术（无肿瘤切除术）并未降低并发症风险。