University of Lausanne, Quartier Centre, 1015, Lausanne, Switzerland.
Department of Surgery, Ospedale Regionale Di Lugano, EOC, Via Tesserete 46, 6900, Lugano, Switzerland.
Langenbecks Arch Surg. 2023 Nov 17;408(1):438. doi: 10.1007/s00423-023-03179-7.
The number of elderly patients with a diagnosis of colorectal cancer (CRC) is increasing. Considering short life expectancy and multiple comorbidities, surgery may not always be the best treatment option.
We included all consecutive patients aged 80 years and older who underwent elective resection for CRC following Enhanced Recovery after Surgery (ERAS) protocol between January 2011 and May 2021. The primary endpoint was overall survival, secondary endpoints were 30-day morbidity, and the rate of return to pre-operative living conditions 3 months after surgery.
Ninety-four patients were included. Mean age was 84.6 ± 3.6 years, 49 patients (52%) were female. Most patients (77.6%) were ASA score ≥ 3. Laparoscopic resections were performed in 85 patients (90.4%), involving 69 (73.4%) colonic and 25 (26.6%) rectal resections. A stoma was constructed in 22 patients (23%), and reversed in 12 (54.5%). Twenty-two patients (23.4%) experienced a Clavien-Dindo ≥ 3 complication, and 2 patients (2.1%) died. The median length of hospital stay was 8 (interquartiles: 6-15) days. Sixty-six patients (70.2%) were discharged home directly and 26 (27.7%) to rehabilitation or postacute care institutes. At three months after surgery, eighty-two patients (96.5%) returned to their pre-operative living conditions directly or after short-term rehabilitation. Mean follow-up was 53 ± 33 months, estimated 5-year overall survival was 60.3% (95%CI 49.5-71.1%), and disease-free survival was 86.3% (95%CI 78.1-94.4%).
Our study suggests that elderly patients undergoing elective surgery have a high potential to return to preoperative living conditions and good overall- and disease-free survivals, despite significant postoperative morbidity.
诊断为结直肠癌（CRC）的老年患者数量正在增加。考虑到预期寿命较短和多种合并症，手术可能并非总是最佳治疗选择。
我们纳入了所有在 2011 年 1 月至 2021 年 5 月期间接受增强型术后康复（ERAS）方案择期手术治疗的 80 岁及以上连续 CRC 患者。主要终点是总生存，次要终点是 30 天发病率和术后 3 个月恢复术前生活条件的比率。
共纳入 94 例患者。平均年龄为 84.6±3.6 岁，49 例（52%）为女性。大多数患者（77.6%）的 ASA 评分≥3。85 例（90.4%）患者接受了腹腔镜切除术，其中 69 例（73.4%）为结肠切除术，25 例（26.6%）为直肠切除术。22 例（23%）患者构建了造口，其中 12 例（54.5%）被逆转。22 例（23.4%）患者发生 Clavien-Dindo≥3 级并发症，2 例（2.1%）患者死亡。中位住院时间为 8（四分位距：6-15）天。66 例（70.2%）患者直接出院回家，26 例（27.7%）患者出院至康复或后期护理机构。术后 3 个月时，82 例（96.5%）患者直接或短期康复后恢复术前生活条件。平均随访时间为 53±33 个月，估计 5 年总生存率为 60.3%（95%CI 49.5-71.1%），无疾病生存率为 86.3%（95%CI 78.1-94.4%）。
我们的研究表明，尽管术后发病率较高，但接受择期手术的老年患者有很高的潜力恢复术前生活条件，并获得良好的总生存和无病生存。
