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403例80岁以上结肠癌患者根治性手术的安全性和疗效分析

Safety and Efficacy Analysis of Radical Surgery for 403 Patients with Colon Cancer over 80 Years Old.

作者信息

Niu Ruilong, Bao Mandula, Jiang Yujuan, Zhang Jinjie, Qin Xiaowei, Zhang Kangkang, Bi Jianjun, Xing Wei, Guo Wei, Liang Jianwei

机构信息

Department of Gastrointestinal Surgery, Affiliated Heji Hospital of Changzhi Medical College, Changzhi, Shanxi, 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.

出版信息

J Cancer. 2024 Mar 25;15(9):2837-2844. doi: 10.7150/jca.94016. eCollection 2024.

DOI:10.7150/jca.94016
PMID:38577607
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10988305/
Abstract

To investigate the safety and efficacy of radical surgery in colon cancer patients over 80 years old. Data from colon cancer patients aged ≥80 years who underwent radical surgery at the Cancer Hospital of the Chinese Academy of Medical Sciences and affiliated Heji Hospital of Changzhi Medical College from January 2011 to December 2022 were retrospectively analysed. Data on clinical characteristics, pathological features, perioperative data, and long-term prognosis were collected. Severe complications were classified as grade III-V. Logistic regression models were used to identify the risk factors for severe postoperative complications, and a Cox regression model was used to determine prognostic variables. A total of 403 eligible patients were included in the study. A total of 118 (29.3%) patients developed postoperative complications, of which 51 (12.7%) experienced grade 3-5 severe complications. Two (0.5%) patients died of pulmonary embolism and myocardial infarction during the perioperative period. The multivariate logistic regression analysis showed that preoperative albumin levels <35 g/L and right colon cancer were independent risk factors for grade 3-5 postoperative complications. In terms of prognosis, multivariate analysis revealed that overall survival was significantly affected by TNM stage III and grade 3-4 postoperative complications. In addition, TNM stage III and perineural invasion were the independent prognostic factors for disease-free survival. Radical surgery can be performed safely in elderly colon cancer patients aged over 80 years, with an acceptable morbidity and mortality. Patients with preoperative albumin levels <35 g/L or tumors in the right colon should be alerted to the development of severe postoperative complications. In addition, the occurrence of severe complications can significantly affect the prognosis of elderly colon cancer patients.

摘要

探讨80岁以上结肠癌患者根治性手术的安全性和疗效。回顾性分析2011年1月至2022年12月在中国医学科学院肿瘤医院及长治医学院附属和平医院接受根治性手术的≥80岁结肠癌患者的数据。收集临床特征、病理特征、围手术期数据和长期预后的数据。严重并发症分为Ⅲ - Ⅴ级。采用Logistic回归模型确定术后严重并发症的危险因素,采用Cox回归模型确定预后变量。本研究共纳入403例符合条件的患者。共有118例(29.3%)患者发生术后并发症,其中51例(12.7%)发生3 - 5级严重并发症。2例(0.5%)患者在围手术期死于肺栓塞和心肌梗死。多因素Logistic回归分析显示,术前白蛋白水平<35 g/L和右半结肠癌是术后3 - 5级并发症的独立危险因素。在预后方面,多因素分析显示,TNMⅢ期和术后3 - 4级并发症对总生存有显著影响。此外,TNMⅢ期和神经侵犯是无病生存的独立预后因素。80岁以上老年结肠癌患者可安全地进行根治性手术,发病率和死亡率可接受。术前白蛋白水平<35 g/L或右半结肠癌患者应警惕术后严重并发症的发生。此外,严重并发症的发生可显著影响老年结肠癌患者的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb31/10988305/bcfc86ece9f6/jcav15p2837g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb31/10988305/f36369d370b2/jcav15p2837g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb31/10988305/bcfc86ece9f6/jcav15p2837g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb31/10988305/f36369d370b2/jcav15p2837g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb31/10988305/bcfc86ece9f6/jcav15p2837g002.jpg

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本文引用的文献

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Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old.80 岁以上老年人大肠癌患者的临床表现、分子特征、治疗方法和转归。
Medicina (Kaunas). 2023 Aug 29;59(9):1574. doi: 10.3390/medicina59091574.
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Clinical Updates for Colon Cancer Care in 2022.2022年结肠癌治疗的临床进展
Clin Colorectal Cancer. 2022 Sep;21(3):198-203. doi: 10.1016/j.clcc.2022.05.006. Epub 2022 Jun 3.
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High-grade postoperative complications affect survival outcomes of patients with colorectal Cancer peritoneal metastases treated with Cytoreductive surgery and Hyperthermic Intraperitoneal chemotherapy.
结直肠癌腹膜转移患者行细胞减灭术和腹腔热灌注化疗后,高等级术后并发症影响生存结局。
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Prognostic factors influencing survival in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for isolated colorectal peritoneal metastases: a systematic review and meta-analysis.影响细胞减灭术联合腹腔热灌注化疗治疗孤立性结直肠腹膜转移患者生存的预后因素:系统评价和荟萃分析。
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Predictive risk factors for anastomotic leakage after anterior resection of rectal cancer in elderly patients over 80 years old: an analysis of 288 consecutive patients.80 岁以上老年患者直肠癌前切除术后吻合口漏的预测风险因素:288 例连续患者分析。
World J Surg Oncol. 2019 Jun 29;17(1):112. doi: 10.1186/s12957-019-1655-z.
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Postoperative complications following colonic resection for cancer are associated with impaired long-term survival.结直肠癌术后并发症与长期生存不良有关。
Colorectal Dis. 2019 Jul;21(7):805-815. doi: 10.1111/codi.14613. Epub 2019 Apr 3.
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Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer.男性性别和缺血性心脏病史是直肠癌患者腹腔镜前切除术后吻合口漏的主要危险因素。
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Is colorectal surgery beyond the age of 80 still feasible with acceptable mortality? An analysis of the predictive value of CR-POSSUM and life expectancy after hospital discharge.80岁以上患者的结直肠手术是否仍可行且死亡率可接受?CR-POSSUM预测价值及出院后预期寿命分析。
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