Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
BMC Surg. 2023 May 15;23(1):127. doi: 10.1186/s12893-023-02039-x.
The aim of this study was to analyze the effect of preoperative bicarbonate and lactate levels (LL) on the short-term outcomes and prognosis in elderly (≥ 65 years) patients with colorectal cancer (CRC).
We collected the information of CRC patients from Jan 2011 to Jan 2020 in a single clinical center. According to the results of preoperative blood gas analysis, we divided patients into the higher/lower bicarbonate group and the higher/lower lactate group, and compared their baseline information, surgery-related information, overall survival (OS) and disease-free survival (DFS).
A total of 1473 patients were included in this study. Comparing the clinical data of the higher/lower bicarbonate group and the higher/lower lactate group, the lower group were older (p < 0.01), had higher rates of coronary heart disease (CHD) (p = 0.025), a higher proportion of colon tumors (p < 0.01), larger tumor size (p < 0.01), higher rates of open surgery (p < 0.01), more intraoperative blood loss (p < 0.01), higher overall complications (p < 0.01) and 30-day deaths (p < 0.01). The higher LL patients had more male patients (p < 0.01), higher body mass index (BMI) (p < 0.01) and drinking rates (p = 0.049), higher rates of type 2 diabetes mellitus (T2DM) (p < 0.01) and lower rates of open surgery (p < 0.01). In multivariate analysis, age (p < 0.01), BMI (p = 0.036), T2DM (p = 0.023), and surgical methods (p < 0.01) were independent risk factors of overall complications. The independent risk factors for OS included age (p < 0.01), tumor site (p = 0.014), tumor stage (p < 0.01), tumor size (p = 0.036), LL (p < 0.01), and overall complications (p < 0.01). The independent risk factors of DFS included age (p = 0.012), tumor site (p = 0.019), tumor stage (p < 0.01), LL (p < 0.01), and overall complications (p < 0.01).
Preoperative LL significantly affected postoperative OS and DFS of CRC patients, but bicarbonate might not affect the prognosis of CRC patients. Therefore, surgeons should actively focus on and adjust the LL of patients before surgery.
本研究旨在分析术前碳酸氢盐和乳酸水平（LL）对老年（≥65 岁）结直肠癌（CRC）患者短期预后的影响。
我们收集了 2011 年 1 月至 2020 年 1 月期间单一临床中心的 CRC 患者信息。根据术前血气分析结果，我们将患者分为碳酸氢盐较高/较低组和乳酸较高/较低组，并比较了两组的基线资料、手术相关资料、总生存期（OS）和无病生存期（DFS）。
本研究共纳入 1473 例患者。比较碳酸氢盐较高/较低组和乳酸较高/较低组的临床数据，低水平组年龄更大（p<0.01），冠心病（CHD）发生率更高（p=0.025），结肠肿瘤比例更高（p<0.01），肿瘤更大（p<0.01），开腹手术比例更高（p<0.01），术中出血量更多（p<0.01），总体并发症发生率更高（p<0.01），30 天死亡率更高（p<0.01）。乳酸水平较高的患者中男性更多（p<0.01），体重指数（BMI）更高（p<0.01），饮酒率更高（p=0.049），2 型糖尿病（T2DM）发生率更高（p<0.01），开腹手术比例更低（p<0.01）。多因素分析显示，年龄（p<0.01）、BMI（p=0.036）、T2DM（p=0.023）和手术方式（p<0.01）是总体并发症的独立危险因素。OS 的独立危险因素包括年龄（p<0.01）、肿瘤部位（p=0.014）、肿瘤分期（p<0.01）、肿瘤大小（p=0.036）、乳酸水平（p<0.01）和总体并发症（p<0.01）。DFS 的独立危险因素包括年龄（p=0.012）、肿瘤部位（p=0.019）、肿瘤分期（p<0.01）、乳酸水平（p<0.01）和总体并发症（p<0.01）。
术前乳酸水平显著影响 CRC 患者的术后 OS 和 DFS，但碳酸氢盐可能不会影响 CRC 患者的预后。因此，外科医生应在术前积极关注并调整患者的乳酸水平。
