Ma Qingbiao, Li Hongyu, Jiang Yujuan, Wang Yingfei, Liang Jianwei
Department of General Surgery, Liaoyang Central Hospital, Liaoyang, China.
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Surg. 2023 Aug 22;10:1251461. doi: 10.3389/fsurg.2023.1251461. eCollection 2023.
The treatment strategy for elderly colorectal cancer patients with intestinal obstruction remains controversial. The choice of reasonable treatment and surgical method directly affects perioperative safety and prognosis. This study investigated the safety and long-term efficacy of radical surgery in elderly colorectal cancer patients over 80 years old with intestinal obstruction.
The clinicopathological data of elderly patients over 80 years old with intestinal obstruction who underwent colorectal cancer surgery from January 2012 to December 2021 were retrospectively collected and analysed. Patients were assigned to a radical group and a palliative group according to the surgical method. Propensity score matching (PSM) was performed to match patients in the radical group 1:1 with those in the palliative group. The perioperative-related indexes and prognosis were compared between the two groups.
A total of 187 patients were enrolled in this study. After PSM, 58 matched pairs were selected, and the radical and palliative groups were well balanced in terms of the clinical and surgical characteristics (> 0.05). The proportion of patients transferred to the ICU after surgery in the radical group was significantly higher than that in the palliative group (17.2% vs. 5.2%, = 0.039). In terms of postoperative complications, the incidence of grade 1-5 complications in the radical group was significantly higher than that in the palliative group (37.9% vs. 15.5%, = 0.006); however, there was no significant difference in the incidence of grade 3-5 complications between the two groups (6.9% vs. 1.7%, = 0.364). In addition, the complications were subclassified, and it was found that the incidence of gastrointestinal disorders (20.7% vs. 6.9%, = 0.031) after surgery was significantly higher in the radical group. The 3-year OS rates were 55.2% and 22.6% in the radical and palliative groups, respectively (< 0.001). Multivariate analysis revealed that radical surgery was an independent prognostic factor for OS (HR: 4.32; 95% CI, 1.93-12.45; < 0.001).
Although elderly colorectal cancer patients over 80 years of age with intestinal obstruction are more likely to be admitted to the ICU and develop more postoperative complications after radical surgery, long-term survival benefits can be achieved.
老年结直肠癌肠梗阻患者的治疗策略仍存在争议。合理治疗方式及手术方法的选择直接影响围手术期安全性及预后。本研究探讨80岁以上老年结直肠癌肠梗阻患者行根治性手术的安全性及长期疗效。
回顾性收集并分析2012年1月至2021年12月期间行结直肠癌手术的80岁以上老年肠梗阻患者的临床病理资料。根据手术方式将患者分为根治组和姑息组。采用倾向评分匹配（PSM）法将根治组患者与姑息组患者1:1匹配。比较两组围手术期相关指标及预后。
本研究共纳入187例患者。PSM后，选取58对匹配病例，根治组和姑息组在临床及手术特征方面均衡性良好（>0.05）。根治组术后转入ICU的患者比例显著高于姑息组（17.2% 对5.2%，P = 0.039）。在术后并发症方面，根治组1 - 5级并发症发生率显著高于姑息组（37.9% 对15.5%，P = 0.006）；然而，两组3 - 5级并发症发生率无显著差异（6.9% 对1.7%，P = 0.364）。此外，对并发症进行亚分类后发现，根治组术后胃肠道紊乱发生率显著高于姑息组（20.7% 对6.9%，P = 0.031）。根治组和姑息组的3年总生存率分别为55.2%和22.6%（P < 0.001）。多因素分析显示，根治性手术是总生存的独立预后因素（HR：4.32；95%CI，1.93 - 12.45；P < 0.001）。
尽管80岁以上老年结直肠癌肠梗阻患者行根治性手术后更易入住ICU且术后并发症更多，但可实现长期生存获益。
