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首页> 外文期刊>Journal of Surgical Oncology >Rectal cancer surgery in the elderly: a multivariate analysis of outcome risk factors.
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Rectal cancer surgery in the elderly: a multivariate analysis of outcome risk factors.

机译：老年人直肠癌手术：结果危险因素的多元分析。

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BACKGROUND AND OBJECTIVES: Geriatric population life expectancy is rapidly increasing and the impact of major surgical procedures is not well defined. The purpose of this study was to compare short term surgical results assessing mortality and morbidity and long-term survival and disease-free interval in elective rectal surgery patients older than 65 years of age. The main independent risk factors of mortality, morbidity, and overall and disease-free survival were also identified. METHODS: Out of 177 rectal cancer accepted consecutively from 1991 to 2002, we studied the main clinical and pathological parameters comparing patients older and younger than 65 years. Data have been collected in a database and variables considered were studied by univariate analysis; independent predictive factors of 30-day mortality and morbidity were identified by multiple logistic regression analysis. Overall, cancer specific and disease-free survival curves were obtained with the Kaplan-Meier method and results compared with the log-rank test. Independent risk factors of overall and disease-free survival have been identified by multivariate logistic regression analysis. RESULTS: In patients younger and older than 65 years postoperative mortality (3.2% vs. 9.6%) and morbidity (30% vs. 29%) were not significantly different. Variables independently associated with 30-day mortality were the duration of surgical procedures and postoperative complications. The Kaplan-Meier survival curves showed a significantly worst overall survival (P = 0.003), cancer specific survival (P = 0.02), and disease-free survival (P = 0.03) in patients aged 65 years or more. Multivariate analysis showed that pT, grading, preoperative CEA level, gender, and site of the tumor along the rectum, the number of blood transfusion and the age group of more than 65 years are independent risk factors for both overall survival and disease-free interval. The presence of residual disease was an adjunctive factor of overall survival, whereas the Astler and Coller staging was a risk factor for the disease-free survival. CONCLUSION: The short-term prognosis for elective rectal cancer procedure in patients over 65 years of age was comparable to that of younger patients, whereas long term cancer-related survival was statistically worst in older patients.
机译：背景与目的：老年人的预期寿命正在迅速增加，并且主要外科手术的影响尚不明确。这项研究的目的是比较短期手术结果，以评估65岁以上的选择性直肠手术患者的死亡率和发病率以及长期生存和无病间隔。还确定了死亡率，发病率以及总体生存率和无疾病生存率的主要独立危险因素。方法：从1991年至2002年连续接受的177例直肠癌中，我们研究了比较65岁以上年龄和年轻患者的主要临床和病理学参数。已经在数据库中收集了数据，并通过单变量分析研究了所考虑的变量;通过多元逻辑回归分析确定30天死亡率和发病率的独立预测因素。总体而言，使用Kaplan-Meier方法获得了癌症特异性和无病生存曲线，并将结果与​​对数秩检验进行了比较。总体和无病生存的独立危险因素已通过多元逻辑回归分析确定。结果：在65岁以下的患者中，术后死亡率（3.2％对9.6％）和发病率（30％对29％）没有显着差异。与30天死亡率独立相关的变量是手术过程的持续时间和术后并发症。 Kaplan-Meier生存曲线显示65岁或65岁以上患者的总生存期（P = 0.003），癌症特异性生存期（P = 0.02）和无病生存期（P = 0.03）显着最差。多因素分析表明，pT，分级，术前CEA水平，性别和直肠肿瘤部位，输血次数和65岁以上年龄组是总体生存和无病间隔的独立危险因素。残留疾病的存在是总体生存的辅助因素，而Astler和Coller分期是无疾病生存的危险因素。结论：65岁以上患者的选择性直肠癌手术的短期预后与年轻患者相当，而在老年患者中与癌症相关的长期存活率在统计学上最差。

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