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老年与非老年患者行结直肠切除术后的短期结局:一项单中心回顾性分析

Short-Term Postoperative Outcomes after Resective Colorectal Surgery in Elderly vs. Nonelderly Patients: A Single Centre Retrospective Analysis.

作者信息

Tondolo Vincenzo, Marzi Federica, Amodio Luca Emanuele, Rizzo Gianluca

机构信息

Digestive and Colo-Rectal Surgery Unit, Ospedale Isola Tiberina Gemelli Isola, 00186 Rome, Italy.

出版信息

Cancers (Basel). 2024 Sep 30;16(19):3358. doi: 10.3390/cancers16193358.

Abstract

Life expectancy for people in their 60s is 24.3 years in high-income countries. Health systems face the burden of disease in the elderly population and must assess the impact of treatments such as major surgery. The aim of this study is to quantify the impact of advanced age on short-term postoperative outcomes after resective colorectal surgery (RCRS). : All patients who underwent RCRS at our institution between July 2022 and November 2023 were entered into a database. Preoperative, perioperative, and early (within 30 days) postoperative data were recorded. Patients were categorized into a young group (under 75 years, YG) and an elderly group (over 75 years, EG). A retrospective comparative analysis of postoperative outcomes was performed between the two groups; postoperative complications were graded according to the Clavien classification. : Fifty-three and ninety-five patients were in the EG and YG, respectively. Indications for RCRS was cancer in 83% of EG patients and 61.1% of YG patients ( = 0.006), and the clinical presentation, localization, and rate of neoadjuvant treatment in oncological patients were comparable. Another indication for RCRS was complicated diverticular disease (17% of EG patients and 38.9% of YG patients; = 0.006). With respect to the baseline characteristics, the ASA and CCI scores were worse in the EG ( = 0.001). No significant differences in the surgical approach, mini-invasive approach, conversion rate, definitive stoma creation, or number of harvested lymph nodes were found between the two groups. Overall, EG reported a higher relative risk (RR) of short-term postoperative complications (1.64, CI: 1.03-2.63), but no significant differences were found in terms of grade ≥3 complications (RR: 0.9, CI: 0.23-3.44). In the EG, a higher risk of ICU admission (RR:2.69, CI: 1.5-4.8) and a one-day longer postoperative hospital stay (6 vs. 5 days) were reported. : Advanced age does not seem to contraindicate RCRS, especially in colorectal cancer patients. The impact of elderly age on short-term outcomes seems to be minimal and acceptable.

摘要

在高收入国家,60多岁人群的预期寿命为24.3岁。卫生系统面临老年人群的疾病负担,必须评估诸如大手术等治疗方法的影响。本研究的目的是量化高龄对结直肠癌根治性手术(RCRS)术后短期结局的影响。:2022年7月至2023年11月期间在我们机构接受RCRS的所有患者被录入数据库。记录术前、围手术期和术后早期(30天内)的数据。患者被分为年轻组(75岁以下,YG)和老年组(75岁以上,EG)。对两组术后结局进行回顾性比较分析;术后并发症根据Clavien分类进行分级。:分别有53例和95例患者在EG组和YG组。EG组83%的患者和YG组61.1%的患者RCRS的指征为癌症(P = 0.006),肿瘤患者的临床表现、病变部位和新辅助治疗率具有可比性。RCRS的另一个指征是复杂性憩室病(EG组患者为17%,YG组患者为38.9%;P = 0.006)。关于基线特征,EG组的ASA和CCI评分更差(P = 0.001)。两组在手术方式、微创方式、中转率、确定性造口形成或获取的淋巴结数量方面未发现显著差异。总体而言,EG组术后短期并发症的相对风险(RR)更高(1.64,CI:1.03 - 2.63),但在≥3级并发症方面未发现显著差异(RR:0.9,CI:0.23 - 3.44)。在EG组,报告了更高的入住重症监护病房风险(RR:2.69,CI:1.5 - 4.8)和术后住院时间延长一天(6天对5天)。:高龄似乎并不 contraindicate RCRS,尤其是在结直肠癌患者中。老年对短期结局的影响似乎最小且可接受。

原文中“contraindicate”这个词有误,可能是“contradict”,但按照要求未做修改。

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