Chen Ke, Li Ming, Xu Ran, Zheng Ping-Ping, Chen Meng-Ding, Zhu Liang, Wang Wen-Bin, Wang Zheng-Guang
Department of Vascular Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210000, Jiangsu Province, China.
College of Pharmacy of Anhui Medical University, Hefei 230001, Anhui Province, China.
World J Gastrointest Surg. 2023 Aug 27;15(8):1739-1750. doi: 10.4240/wjgs.v15.i8.1739.
Whether patients over 85 years old with gastrointestinal cancer should undergo surgery remains controversial. We aimed to describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan.
To describe the changing trends of characteristics to provide more information to decision makers, and strive to find appropriate surgical plan.
A total of 218 gastric cancer (GC) patients and 563 colorectal cancer (CRC) patients who underwent surgery between 2001 and 2021 were enrolled in this retrospective analysis. Changes in clinicopathological features, surgical treatments, and survival status were analyzed longitudinally at 5-year intervals.
Only 14 GC patients underwent laparoscopic surgery where 219 CRC patients had this procedure. Cardia and esophagogastric junction cancer increased in GC patients, and the proportion of sigmoid colon cancer decreased in CRC patients. Pulmonary infection gradually became the most common postoperative complication, its incidence in period 4 reached 48.79%. However, the incidence of anastomotic leakage decreased from 26.79% to 9.38% ( < 0.01). Additionally, 30-d mortality significantly decreased from 32.14% to 9.01%. Increases were observed in 5-year overall survival (OS) in GC patients from period 1 to period 4 (18.18% 33.32%, respectively) and CRC patients (0 36.32%, respectively). Disease-free survival (DFS) also increased in GC and CRC patients (7.14% 27.74% and 0 to 36.03%, respectively). The average survival time of GC patients following radial lymphadenectomy was higher than in patients that underwent limited lymphadenectomy (26 22 mo, respectively), the same was seen in CRC patients (44 33 mo, respectively). This advantage was particularly evident in patients with TNM I, but not in patients with TNM II/III period cancer.
The safety as well as effectiveness of surgery in ultra-elderly patients is increasing. Radical lymphadenectomy has advantages in patients with TNM I gastrointestinal cancer, but not TNM II/III.
85岁以上的胃肠道癌患者是否应接受手术仍存在争议。我们旨在描述特征的变化趋势，为决策者提供更多信息，并努力找到合适的手术方案。
描述特征的变化趋势，为决策者提供更多信息，并努力找到合适的手术方案。
本回顾性分析纳入了2001年至2021年间接受手术的218例胃癌患者和563例结直肠癌患者。每隔5年纵向分析临床病理特征、手术治疗和生存状况的变化。
仅14例胃癌患者接受了腹腔镜手术，219例结直肠癌患者接受了该手术。胃癌患者中心脏和食管胃交界癌增多，结直肠癌患者中乙状结肠癌比例下降。肺部感染逐渐成为最常见的术后并发症，其在第4阶段的发生率达到48.79%。然而，吻合口漏的发生率从26.79%降至9.38%（<0.01）。此外，30天死亡率从32.14%显著降至9.01%。胃癌患者从第1阶段到第4阶段的5年总生存率（OS）有所提高（分别为18.18%和33.32%），结直肠癌患者也如此（分别为0和36.32%）。胃癌和结直肠癌患者的无病生存期（DFS）也有所提高（分别从7.14%提高到27.74%和从0提高到36.03%）。接受根治性淋巴结清扫术的胃癌患者的平均生存时间高于接受有限淋巴结清扫术的患者（分别为26个月和22个月），结直肠癌患者也是如此（分别为44个月和33个月）。这一优势在TNM I期患者中尤为明显，但在TNM II/III期癌症患者中不明显。
超高龄患者手术的安全性和有效性正在提高。根治性淋巴结清扫术对TNM I期胃肠道癌患者有优势，但对TNM II/III期患者无优势。
