Risks Factors for Postoperative Mortality after Colorectal Cancer Resection

大腸直腸癌術後死亡之危險因子探討

黃任嫻(Jen-Hsien Huang) ； 林春吉(Chun-Chi Lin) ； 林宏鑫(Hung-Hsin Lin) ； 藍苑慈(Yuan-Tsiu Lan) ； 張世慶(Shin-Ching Chang) ； 王煥昇(Huann-Sheng Wang) ； 楊純豪(Shung-Haur Yang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin) ； 姜正愷(Jeng-Kai Jiang)

《中華民國大腸直腸外科醫學會雜誌》 28卷4期 (2017/12) Pp. 177-184

https://doi.org/10.6312/SCRSTW.2017.28(4).10614

摘要

Purpose. Colorectal cancer surgery is associated with a 1.3%-8.5% mortality rate. The variation in these outcomes may be attributed to the quality of care. This study aimed to identify independent risk factors for postoperative mortality. Methods. Patients that underwent resection for colorectal cancer in a single medical center from January 1993 to December 2011 were identified from a prospectively maintained database. Data including clinicopathological features, operation methods, and in-hospital complications were collected. Postoperative mortality was defined as death within 90 days after surgery. The risks factors were analyzed by logistic regression analysis. Results. There were 5609 patients included in this study. The mean age of the patients was 62.6 years, and 3591 (62.0%) were male. Among these patients, 134 patients died within 90 days. The postoperative mortality rate was 2.4%, and the in-hospital complication rate was 21.5%. Independent risk factors for postoperative mortality were age ≥ 65 years, postoperative complications (especially cardiopulmonary complications), elevated carbohydrate antigen 19-9, and lymphoma. Conclusions. Recognition of these risk factors could help to improve the care of patients with colorectal cancer preparing for surgery.

關鍵字

Colorectal cancer ； Postoperative mortality ； Complication

並列摘要

目的：在過去研究中，病患接受腸切除術後的死亡率約1.3%到8.5%。這些術後存活率的差異可能與病患術前評估及術後照護的品質有關。本篇研究主要目的是要探討可能影響大腸直腸癌病患接受腸切除術後死亡的可能因子。方法：研究主要是從前瞻性建立之資料庫回溯統計從1993年1月至2011年12月期間於單一醫學中心因大腸直腸癌接受腸切除手術的病患。研究主要評估癌症的部位、病理分期、病患年齡、性別、共病情況、手術方式、術前輔助治療、及術後併發症等因子。術後死亡率定義為病患在接受術後90天內死亡。這些可能危險因子與術後死亡率之相關性是以多元邏輯迴歸分析作統計。結果：共有5609位大腸直腸癌病患接受腸切除手術。病患群的平均年齡為62.6歲，而其中有3591(62%)名病患為男性。在其中共有134名病患於術後90天內死亡。其術後死亡率為2.4%；而術後併發症發生率為21.5%。經多變項分析後，可能影響病患接受大腸直腸癌切除手術後死亡的獨立因子包括病患年齡≥ 65歲、術後併發症(尤其心肺相關併發症)、CA 19-9 ＞ 37 U/ml和淋巴癌。結論：在本篇研究中，病患年齡≥65歲、術後併發症(尤其心肺相關併發症)、CA 19-9 ＞ 37 U/ml和淋巴癌為可能影響病患因大腸直腸癌接受腸切除手術後死亡的危險因子。在安排具有以上這些危險因子之大腸直腸癌症病患接受腸切除手術時應更加注意，以期增進大腸直腸癌腸病患之照護醫療品質。

並列關鍵字

大腸直腸癌 ； 術後死亡率 ； 併發症

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