Surgery for colorectal cancer in elderly patients: a systematic review
Surgery for colorectal cancer in elderly patients: a systematic review
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DOI：
10.1016/s0140-6736(00)02713-6
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发表时间：
2000-09-16
期刊：
影响因子：
168.9
通讯作者：
Violi, V
中科院分区：
文献类型：
--
作者：
Simmonds, P;Best, L;Violi, V
结直肠癌手术的有效性取决于手术的安全性，这使得大多数患者能够恢复生产生活，提高术后预期寿命，或者至少不会因手术而减少。由于结直肠癌是发病率和死亡率在老年人的一个主要原因，我们已经研究了如何在老年患者的手术结果不同，从那些在年轻patients.Methods我们做了一个系统的审查，研究人员提供的出版和汇总数据。通过计算机和手动检索已发表和未发表的报告、扫描参考文献和联系研究者来识别研究。在每项研究中，65-74岁，75-84岁和85岁以上患者的结局与65岁以下患者的结局相关。结果从28项独立研究，共34194例患者中，我们发现老年患者的共病频率增加，更有可能出现晚期疾病并接受急诊手术，并且比年轻患者更不可能进行根治性手术。术后并发症和死亡率随年龄增长而增加。老年患者的总体生存率降低，但癌症特异性生存年龄相关的差异少得多striking.Interpretation年龄和结直肠癌手术结果之间的关系是复杂的，可能会混淆的差异，在介绍阶段，肿瘤部位，预先存在的合并症，和接受的治疗类型。然而，选定的老年患者受益于手术，因为很大一部分存活2年或更长时间，无论他们的年龄。
Background The effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives, with an improved postoperative life expectancy, or at least one that is not diminished by the surgery. Because colorectal cancer is a major cause of morbidity and mortality in elderly people, we have examined how the outcomes of surgery in elderly patients differ from those in younger patients.Methods We did a systematic review of published and aggregate data provided by investigators. Studies were identified by computerised and manual searches of published and unpublished reports, scanning references, and contacting investigators. Within each study, outcomes for patients aged 65-74 years, 75-84 years, and 85+ years were expressed in relation to those aged less than 65 years.Findings From 28 independent studies, and a total of 34 194 patients, we found that elderly patients had an increased frequency of comorbid conditions, were more likely to present with later-stage disease and undergo emergency surgery, and less likely to have curative surgery than younger patients. The incidence of postoperative morbidity and mortality increased progressively with advancing age. Overall survival was reduced in elderly patients, but for cancer specific survival age-related differences were much less striking.Interpretation The relation between age and outcomes from colorectal cancer surgery is complex and may be confounded by differences in stage at presentation, tumour site, pre-existing comorbidities, and type of treatment received. However, selected elderly patients benefit from surgery since a large proportion survive for 2 or more years, irrespective of their age.