The Surgical Outcome of Tumor Resection Surgery for Octogenarian Patients with Colorectal Cancer

極老人接受大腸直腸腫瘤手術的預後

林艿律(Nai-Lu Lin) ； 王煥昇(Huann-Sheng Wang) ； 姜正愷(Jeng-Kae Jiang) ； 林宏鑫(Hung-Hsin Lin) ； 林春吉(Chun-Chi Lin) ； 藍苑慈(Yuan-Tzu Lan) ； 張世慶(Shih-Ching Chang) ； 楊純豪(Shung-Haur Yang) ； 陳維熊(Wei-Shone Chen) ； 林資琛(Tzu-Chen Lin) ； 林楨國(Jen-Kou Lin)

《中華民國大腸直腸外科醫學會雜誌》 29卷1期 (2018/03) Pp. 22-28

https://doi.org/10.6312/SCRSTW.2018.29(1).10621

摘要

Purpose. Although surgical resection is the main treatment for colorectal cancer, the optimal protocol for octogenarian patients remains undetermined. Our study aimed to evaluate the effect of surgery in these patients. Methods. This retrospective study was performed on patients aged ＞ 65 years diagnosed with colorectal cancer and who underwent tumor resection surgery from 2005 to 2009 at the Taipei Veterans General Hospital. Normally distributed data were presented as mean and examined with the Student’s t test. Results. A total of 854 elderly patients were recruited with subgroups of elderly patients (＜ 80 years old, n = 388) and octogenarian patients (_ 80 years old, n = 466). Longer lengths of hospital stay and higher rates of severe complications were noted in octogenarian patients. Postoperative cerebral vascular accident, myocardial infarction, arrhythmia, and respiratory failure were more common in the octogenarian sub cohort. For those diagnosed with stage III colorectal cancer, the rate of adjuvant chemotherapy in octogenarian patients was lower than that in younger patients. Conclusions. In conclusion, tumor resection surgery for colorectal cancer in octogenarian patients was well tolerated. Age alone was not the only indication for less aggressive therapy, as surgery could still be recommended for select octogenarian patients.

關鍵字

Octogenarian patients ； Colorectal cancer ； Tumor resection

並列摘要

結腸直腸癌的治療方法目前以腫瘤切除手術為主，但是對於年齡大於八十歲患者的最佳治療方法仍未確定。本研究旨在評估腫瘤切除手術對這些患者的療效。這項回顧性研究收錄2005年至2009年間在台北榮民總醫院接受結腸直腸癌腫瘤切除手術的老年患者。正態分佈數據以平均值表示，並用Student's t檢驗進行檢驗。共收錄854名老年患者，其中小於80歲有388位，八十歲以上有466位。研究顯示八十歲以上患者的住院時間較長，嚴重併發症發生率較高，術後腦血管疾病、心肌梗塞、心律不整、呼吸衰竭較常見。對於診斷為第三期結腸直腸癌的患者，八十歲以上族群接受術後輔助化學治療的比率較低。雖然八十歲以上患者有較高術後併發症，但整體術後耐受性良好。年齡不應該作為拒絕手術的單一考量，手術對於篩選後的八十歲以上患者仍然可以為主要治療。

並列關鍵字

老年人 ； 結腸直腸癌 ； 腫瘤切除術

參考文獻

Ferlay J, Shin HR, Bray F et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010; 127: 2893-917.

Hermans, E, van Schaik PM, Prins HA, Ernst MF, Dautzenberg PJ, Bosscha K. Outcome of colonic surgery in elderly patients with colon cancer. J Oncol 2010:865908.

Surgery for colorectal cancer in elderly patients: a systemic review. Colorectal Cancer Collaborative Group. Lancet 2000;356:968-74.

Modini C, Romagnoli F, De Milito R, Romeo V, Petroni R, La Torre F, Catani M. Octogenarians: an increasing challenge for acute care and colorectal surgeons. An outcomes analysis of emergency colorectal surgery in the elderly. Colorectal Dis 2012;14: e312-e318.

Jestin P, Nilsson J, Heurgren M, Pahlman L, Glimelius B, Gunnarsson U. Emergency surgery for colonic cancer in a defined population. Br J Surg 2005; 92:94-100.