Laparoscopic vs open colorectal cancer surgery in elderly patients: short- and long-term outcomes and predictors for overall and disease-free survival
Laparoscopic vs open colorectal cancer surgery in elderly patients: short- and long-term outcomes and predictors for overall and disease-free survival
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DOI：
10.1186/s12893-019-0596-3
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发表时间：
2019-09-14
期刊：
影响因子：
1.9
通讯作者：
Liang, Jianwei
中科院分区：
文献类型：
--
作者：
Zhou, Sicheng;Wang, Xuewei;Liang, Jianwei
结直肠癌是一种常见于老年患者的疾病。腹腔镜手术是治疗此类疾病的常用方法。本研究旨在探讨腹腔镜手术和开腹手术治疗老年结直肠癌的近期疗效和长期生存率。方法选取2007年1月至2018年12月在中国肿瘤防治中心接受手术治疗的80岁以上老年结直肠癌患者作为研究对象。倾向评分匹配（PSM）被用来最大限度地减少不良反应。比较开腹手术与腹腔镜手术的临床资料，采用考克斯比例风险模型分析影响总生存期（OS）和无病生存期（DFS）的因素。结果经PSM筛选出93对。腹腔镜组术中出血量少、术后并发症少、首次排气时间短、进食时间短、术后住院时间短、淋巴结清扫率高（P < 0.05）。CEA水平、III/IV期、神经浸润是影响生存的独立因素（P <0.05）。结论腹腔镜手术治疗老年结直肠癌近期疗效优于开腹手术。CEA水平、III/IV期和神经浸润是预测OS和DFS的可靠指标。
Background Colorectal cancer is common in elderly patients. Laparoscopy is widely used to approach this kind of disease. This study was to examine short-term outcomes and long-term survival for laparoscopic and open surgery in elderly patients with colorectal cancer. Methods From January 2007 to December 2018, patients with colorectal cancer older than 80 operated at China National Cancer Center were included in the study. Propensity score matching (PSM) was used to minimize the adverse effects. The clinical data between open and laparoscopic surgery was compared, and the effect of factors on overall survival (OS) and disease-free survival (DFS) was analyzed by Cox proportional hazard model. Results Ninety-three pairs were selected after PSM. Patients in laparoscopic group had less intraoperative blood loss, postoperative complications, time to first flatus, time to oral feeding, postoperative hospital stay, and higher retrieved lymph node (P < 0.05). The OS and DFS rates were similar (P > 0.05), besides the CEA level, III/IV stage, and perineural invasion were independent predictors of survival (P < 0.05). Conclusion In elderly patients with colorectal cancer, laparoscopic surgery had better short-term outcomes than open surgery. CEA level, III/IV stage, and perineural invasion were reliable predictors for OS and DFS.