Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Surgery, Skåne University Hospital, Malmö, Sweden.
Colorectal Dis. 2024 Jul;26(7):1397-1404. doi: 10.1111/codi.17058. Epub 2024 Jun 10.
The incidence of colorectal cancer (CRC) in Sweden is increasing in individuals <50 years. This study aimed to examine differences in postoperative 30-day complications and rate of emergency surgeries in CRC patients <50 years at diagnosis compared to older age groups since population-based research on this topic is scarce.
This population-based study included data from the Swedish Colorectal Cancer Registry for patients undergoing CRC resection between 2010 and 2018. Bivariate analysis and logistic regression were used to analyse the relationship between age groups (<50, 50-79 and ≥80 years) and probability of postoperative 30-day complications adjusted for gender, tumour localization, neoadjuvant (chemo)radiotherapy and American Society of Anesthesiologists score.
In total 33 320 patients were included. Patients <50 years had a lower American Society of Anesthesiologists score, more advanced tumours and received more neoadjuvant treatment. Emergency surgeries were less common in the youngest age group (P < 0.001) as well as overall postoperative 30-day complications: OR 0.84 (95% CI 0.74-0.96) compared to those ≥80 years. Surgical complications were more common in age groups <50 and 50-79 years (16.5% and 16.9% respectively) compared to patients ≥80 years (14.1%) (P < 0.001). Anastomotic leakage and intra-abdominal infections were more frequent in patients <50 years (5.7% and 3.5% respectively) compared to age groups 50-79 years (5.1% and 2.8% respectively) and ≥80 years (3.5% and 2.1% respectively) (P < 0.001). Wound infections were more common in the two youngest age groups compared to patients ≥80 years (5.3% vs. 3.7% respectively) (P < 0.001).
Colorectal cancer patients <50 years and 50-79 years had a higher proportion of surgical complications regarding anastomotic leakage, intra-abdominal infections and wound infections but lower overall postoperative complications. The incidence of surgical emergencies was highest amongst patients ≥80 years. Postoperative diagnostic workup in symptomatic individuals <50 years is warranted.
瑞典 50 岁以下人群的结直肠癌（CRC）发病率正在上升。本研究旨在探讨与年龄较大的患者相比，诊断时<50 岁的 CRC 患者术后 30 天并发症发生率和急诊手术率的差异，因为该主题的基于人群的研究很少。
本研究为基于人群的研究，纳入了 2010 年至 2018 年间接受 CRC 切除术的瑞典结直肠癌登记处的数据。使用双变量分析和逻辑回归分析年龄组（<50 岁、50-79 岁和≥80 岁）与术后 30 天并发症概率之间的关系，调整性别、肿瘤定位、新辅助（化疗）放疗和美国麻醉医师协会评分。
共纳入 33320 例患者。<50 岁的患者美国麻醉医师协会评分较低，肿瘤分期较晚，接受新辅助治疗的比例较高。年龄最小的患者急诊手术较少（P<0.001），术后 30 天总体并发症也较少：与≥80 岁的患者相比，OR 为 0.84（95%CI 0.74-0.96）。与≥80 岁的患者相比，<50 岁和 50-79 岁的患者手术并发症更常见（分别为 16.5%和 16.9%）（P<0.001）。<50 岁的患者吻合口漏和腹腔内感染更常见（分别为 5.7%和 3.5%），50-79 岁和≥80 岁的患者分别为 5.1%和 2.8%（P<0.001）。与≥80 岁的患者相比，两个年龄较小的患者组的伤口感染更为常见（分别为 5.3%和 3.7%）（P<0.001）。
与≥80 岁的患者相比，<50 岁和 50-79 岁的 CRC 患者在吻合口漏、腹腔内感染和伤口感染方面发生手术并发症的比例更高，但整体术后并发症发生率较低。≥80 岁的患者急诊手术发生率最高。对于<50 岁有症状的患者，术后需要进行更多的诊断性检查。
