Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Surg Laparosc Endosc Percutan Tech. 2024 Jun 1;34(3):281-289. doi: 10.1097/SLE.0000000000001281.
The purpose of the current study was to statistically clarify the precise risk age in elderly patients undergoing colorectal surgery and to evaluate the safety and efficacy of laparoscopic colorectal resection in these patients.
Patients' clinical variables were extracted from the database of the Gastrointestinal Surgery Centre, Third Affiliated Hospital of Sun Yat-sen University, from 2015 to 2019. Logistic regression was conducted to identify independent risk factors of postoperative complications and ORs for each age. Curves of odds ratios (ORs) and CIs for each age were fitted by using a locally weighted scatterplot smoother, and a structural breakpoint was determined by the Chow test to identify a precise cutoff risk age for elderly patients. Comparison and subgroup analysis were conducted between surgical approach groups using the Student t test and χ 2 analysis.
Locally weighted scatterplot smoother OR analysis manifested that patients aged 69 years old or older suffered a higher possibility of postoperative complications and should be defined as high-risk age. Comparison according to the high-risk age revealed laparoscopic colorectal surgery is better than laparotomic surgery for elderly individuals in terms of hospital stay (9.46 ± 5.96 vs 15.01 ± 6.34, P < 0.05), the incidence of intensive care unit transfer (4 vs 20, P < 0.05), and incidence of surgical site infection (15 vs 20, P < 0.05). Patients who underwent laparotomic surgery had a greater prevalence of Clavien-Dindo II/III complications ( P < 0.05). These findings remained stable even after propensity matching. Furthermore, such superiority was proved especially significant for patients who underwent left-side colorectal resection. In addition, overall survival was improved in the laparoscopic surgery group, whereas no differences were observed in disease-free survival.
In our study population, age 69 or older was a cutoff point age suggests a higher possibility of postoperative morbidity after colorectal surgery. Laparoscopic colorectal resection should be regarded as a superior therapeutic choice for these elderly individuals, especially for left-side colorectal surgeries.
本研究旨在通过统计学方法明确行结直肠手术的老年患者的确切风险年龄，并评估腹腔镜结直肠切除术在这些患者中的安全性和疗效。
从中山大学附属第三医院胃肠外科中心数据库中提取 2015 年至 2019 年患者的临床变量。采用 logistic 回归分析识别术后并发症的独立危险因素，以及各年龄组的优势比（OR）。采用局部加权散点平滑法拟合优势比（OR）和置信区间（CI）曲线，通过 Chow 检验确定老年患者的精确风险年龄分界点。采用 t 检验和 χ 2 分析比较手术方式组之间的差异和亚组分析。
局部加权散点平滑法 OR 分析显示，年龄 69 岁或以上的患者术后并发症的可能性更高，应定义为高危年龄。根据高危年龄进行比较显示，腹腔镜结直肠手术在住院时间（9.46 ± 5.96 比 15.01 ± 6.34，P < 0.05）、重症监护病房转移发生率（4 比 20，P < 0.05）和手术部位感染发生率（15 比 20，P < 0.05）方面优于剖腹手术。行剖腹手术的患者更易发生 Clavien-Dindo II/III 级并发症（P < 0.05）。即使在倾向评分匹配后，这些发现仍然稳定。此外，这种优势在接受左侧结直肠切除术的患者中更为显著。此外，腹腔镜手术组的总生存率得到提高，而无病生存率无差异。
在本研究人群中，年龄 69 岁或以上是结直肠手术后发生术后发病率较高的截点年龄。对于这些老年患者，腹腔镜结直肠切除术应作为一种更好的治疗选择，尤其是对于左侧结直肠手术。
