Chen Guanchi, Liang Zhonglin, Cui Long
Department of Colorectal and Anal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 200092 Shanghai, China; Shanghai Colorectal Cancer Research Center, 200092 Shanghai, China.
Ann Ital Chir. 2025;96(6):800-810. doi: 10.62713/aic.3919.
Elderly patients are at increased risk of morbidity and prolonged hospital stays following non-emergency colorectal cancer (CRC) surgery. This study aimed to determine which surgical procedures are associated with postoperative morbidity and shorter postoperative hospital stay in elderly patients undergoing colorectal surgery.
Patients aged ≥75 years who underwent CRC resection between June 2015 and May 2019 at one hospital were included in this observational study. Logistic regression models were used to analyze the relationship between different surgical procedures and both overall postoperative complications and surgery-related complications, expressed as odds ratios (ORs) with 95% confidence intervals (CIs). The relationship between surgical procedures and postoperative hospital stay was evaluated using negative binomial regression, reported as incidence rate ratios (IRRs) with 95% CI. Additionally, Cox regression models were applied to assess the association between surgical procedures and postoperative mortality, expressed as hazard ratios (HRs) with 95% CIs.
A total of 442 patients who underwent CRC resection were included, of whom 196 (44.34%) experienced postoperative complications and 121 (27.38%) had surgery-related complications. Patients undergoing anastomosis (adjusted OR = 0.43, 95% CI: 0.22-0.84, p = 0.014) had a lower risk of postoperative complications. Laparoscopy (adjusted OR = 0.51, 95% CI: 0.28-0.89, p = 0.019) was associated with a reduced risk of surgery-related complications. For postoperative hospital stay, laparoscopy (IRR = 0.883, 95% CI: 0.790-0.987, p = 0.027) was associated with shorter stays, whereas stoma formation (IRR = 1.154, 95% CI: 1.006-1.326, p = 0.044) was associated with prolonged hospital stay. Moreover, stoma formation (HR = 5.18, 95% CI: 1.03-25.91, p = 0.045) was associated with an increased risk of postoperative mortality.
Anastomosis and laparoscopy were associated with a lower risk of complications, while stoma formation was related to poorer prognosis in elderly patients undergoing CRC resection. The influence of surgical procedure choice on postoperative outcomes should be carefully considered.
老年患者在非急诊结直肠癌（CRC）手术后发病风险增加，住院时间延长。本研究旨在确定哪些手术方式与接受结直肠手术的老年患者术后发病及较短的术后住院时间相关。
本观察性研究纳入了2015年6月至2019年5月在一家医院接受CRC切除术且年龄≥75岁的患者。采用逻辑回归模型分析不同手术方式与总体术后并发症及手术相关并发症之间的关系，以比值比（OR）及95%置信区间（CI）表示。采用负二项回归评估手术方式与术后住院时间之间的关系，以发病率比（IRR）及95%CI报告。此外，应用Cox回归模型评估手术方式与术后死亡率之间的关联，以风险比（HR）及95%CI表示。
共纳入442例接受CRC切除术的患者，其中196例（44.34%）发生术后并发症，121例（27.38%）发生手术相关并发症。接受吻合术的患者（调整后OR = 0.43，95%CI：0.22 - 0.84，p = 0.014）术后并发症风险较低。腹腔镜手术（调整后OR = 0.51，95%CI：0.28 - 0.89，p = 0.019）与手术相关并发症风险降低相关。对于术后住院时间，腹腔镜手术（IRR = 0.883，95%CI：0.790 - 0.987，p = 0.027）与住院时间缩短相关，而造口形成（IRR = 1.154，95%CI：1.006 - 1.326，p = 0.044）与住院时间延长相关。此外，造口形成（HR = 5.18，95%CI：1.03 - 25.91，p = 0.045）与术后死亡风险增加相关。
吻合术和腹腔镜手术与较低的并发症风险相关，而造口形成与接受CRC切除术的老年患者预后较差相关。应仔细考虑手术方式选择对术后结局的影响。
