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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.

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/f36369d370b2/jcav15p2837g001.jpg

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