Colorectal cancer in the elderly. Is there a role for safe and curative surgery?
Colorectal cancer in the elderly. Is there a role for safe and curative surgery?
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DOI：
10.1111/j.1445-2197.2008.04536.x
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发表时间：
2008-06-01
影响因子：
1.7
通讯作者：
Goletti, Orlando
中科院分区：
文献类型：
--
作者：
Basili, Giancarlo;Lorenzetti, Luca;Goletti, Orlando
背景：最近的报告将结直肠癌 (CRC) 列为男女第三大常见癌症。老年患者通常被视为高风险手术候选者，其急诊就诊率和围手术期死亡率较高。我们研究的目的是调查接受 CRC 手术的老年患者的特征以及围手术期发病率和死亡率。方法：我们回顾性研究了 2003 年 7 月至 2005 年 12 月期间在我们机构接受 CRC 手术的 248 例患者。危险因素包括性别、年龄、癌症定位、Dukes 和 TNM 分类、输血、术前生理和手术严重程度评分 死亡率和发病率分数和呈现方式。主要结局是围手术期死亡。结果：该研究由 143 名男性和 105 名女性组成。一百三十四名 (54%) 患者年龄超过 75 岁。在两个年龄较大的组中，近端结肠癌症比最年轻的年龄组更常见（P = 0.001）。在 25 例急诊切除术中，20 例患者年龄超过 75 岁（P < 0.001）。在择期手术中，75 岁以上患者的围手术期死亡率为 3.1%，而 75 岁以下患者的围手术期死亡率为 0%，而在急诊中，围手术期死亡率为 24% 与 0%（P = 不显着）。在Cox多元回归分析中，年龄和就诊方式达到统计学意义。结论：高龄本身并不是CRC手术的独立负面预后因素。尽管紧急手术的结果不佳，但大多数患者都幸存并出院。这项研究表明，只要有可能，无论年龄如何，都应该对 CRC 患者应用治疗意图。
Background: Recent reports place colorectal cancer (CRC) as the third most common cancer for both sexes. Elderly patients are often viewed as high-risk surgical candidates with high rates of emergency presentations and perioperative mortality. The aim of our study was to examine the characteristics and perioperative morbidity and mortality rates of elderly patients presented to CRC surgery.Methods: We retrospectively studied 248 patients who underwent surgery for CRC at our institution between July 2003 and December 2005. Risk factors included sex, age, cancer localization, Dukes' and TNM classification, blood transfusion, preoperative Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity score and mode of presentation. Primary outcome was perioperative death.Results: The study consisted of 143 men and 105 women. One hundred and thirty-four (54%) patients were more than 75 years of age. In the two older groups, cancer was more common in the proximal colon than in the youngest age group (P = 0.001). Of the 25 resections carried out as emergency, 20 were in those who were more than 75 years of age (P < 0.001). In elective procedure, perioperative mortality scores were 3.1% in those who were more than 75 years of age versus 0% in those less than 75 years, meanwhile in emergency, rates of 24 versus 0% (P = not significant) were registered. In Cox multivariate regression analysis, age and mode of presentation reached statistical significance.Conclusion: Old age itself is not an independent negative prognostic factor for CRC surgery. Although emergency operations were associated with poor outcome, most patients survived and left the hospital. This study suggests that, whenever possible, curative intent should be applied in patients with CRC, irrespective of the age.