Dept. of General and Abdominal Surgery, ZNA Middelheim, Lindendreef 1, B-2020, Antwerp, Belgium.
Dept. of Medical Oncology, ZNA Middelheim, Lindendreef 1, B-2020, Antwerp, Belgium.
Langenbecks Arch Surg. 2023 Dec 18;409(1):13. doi: 10.1007/s00423-023-03201-y.
Colon cancer is the most common intra-abdominal cancer in older people. In the elderly with cancer, clinical decision making is often complicated by the effects of aging. However, as life expectancy continues to rise, more people aged 80 and older will present with colorectal cancer and may need major surgery.
Between 2000 and 2020 we operated on 352 patients aged 80 and older for colorectal cancer. We reviewed the case-notes of these patients and made a survival analysis for those patients who had a surgical resection of the tumor.
In 20 patients a palliative procedure was performed. Three hundred and thirty-two (332) patients had a colorectal cancer resected. Of these, 57 patients died within 90 days postoperatively. Survival analysis was done for 275 patients who were alive longer than 90 days postoperatively. The overall 5-year survival in this group is 41.5%. There was no significant difference in postoperative survival between patients over the age of 85 and patients aged 80-84 at the time of operation. The survival of patients with stage IV colorectal adenocarcinoma is significantly worse than survival in stage I-III patients (Cox-Mantel log-rank test p < 0.001).
After exclusion of the patients in the 90-day mortality group the overall 5-year survival in octogenarians who had a resection of a colorectal cancer was 41.5%. The most difficult problem is to choose the right treatment for the right patient. Optimal surgical and adjuvant treatment should not be denied to these older patients.
结肠癌是老年人中最常见的腹腔内癌症。在患有癌症的老年人中，临床决策往往因衰老的影响而变得复杂。然而，随着预期寿命的持续延长，越来越多的 80 岁及以上的人将患有结直肠癌，并可能需要接受重大手术。
在 2000 年至 2020 年间，我们对 352 名 80 岁及以上的结肠癌患者进行了手术。我们复习了这些患者的病历，并对接受肿瘤切除术的患者进行了生存分析。
20 例患者进行了姑息性手术。332 例（332 例）患者接受了结直肠癌切除术。其中，57 例患者术后 90 天内死亡。对术后存活时间超过 90 天的 275 例患者进行了生存分析。该组患者的 5 年总生存率为 41.5%。在手术时年龄超过 85 岁和 80-84 岁的患者之间，术后生存无显著差异。IV 期结直肠腺癌患者的生存明显差于 I-III 期患者（Cox-Mantel 对数秩检验，p<0.001）。
排除 90 天死亡率组患者后，接受结直肠癌切除术的 80 岁以上患者的 5 年总生存率为 41.5%。最困难的问题是为合适的患者选择合适的治疗方法。不应拒绝这些老年患者接受最佳的手术和辅助治疗。
