腹腔镜肝切除术治疗老年结直肠癌肝转移的短期及长期结局

Short-and long-term outcomes of laparoscopic hepatectomy for elderly patients with colorectal liver metastases

目的比较行腹腔镜肝切除术(laparoscopic hepatectomy,LH)治疗结直肠癌肝转移(colorectal liver metastases,CRLM)的老年患者与中年患者的短期及长期结局。方法 2010年1月至2017年1月,共有207例大于或等于60岁的CRLM患者行LH。根据行LH时的年龄,将患者划分为老年组(年龄大于或等于70岁,68例)和中年组(年龄60~69岁,139例)。比较这两组患者的短期与长期结局。结果术前一般资料比较方面,老年组患者的年龄、Charlson合并症指数、术前化疗的比例以及ASA评分高于中年组,其余的术前一般资料比较差异无统计学意义。除老年组患者的中转率高于中年组之外,两组患者在手术方式、手术时间、术中失血量、术后90天并发症发生率及严重程度、术后90天病死率、病理结果等短期结局比较差异无统计学意义。长期随访结果表明,两组患者的复发率类似。两组患者的总体生存率及无瘤生存率均类似。多因素分析表明,年龄不是影响总体生存率及无瘤生存率的独立预测因素。结论 LH用于老年CRLM患者可取得与中年CRLM患者类似的短期及长期结局,高龄不是行LH的禁忌证。

Objective To evaluate the short-and long-term outcomes of laparoscopic hepatectomy （LH） for colorectal liver metastases （CRLM） in elderly patients. Methods From January 2010 to January 2017,LH was performed for consecutive 207 patients who were 60 years old and above and had CRLM. Based on their age at the LH,the patients were divided into the elderly group （70 years old and above,68 patients） and the middle-aged group （from 60 to 69 years old,139 patients）. The short-term and long-term outcomes were compared between the two groups. Results Compared to the middle-aged group,the elderly group had higher values for age,Charlson comorbidity index,proportion of preoperative chemotherapy,and American Society of Anesthesiologists score. No other significant differences were observed in the preoperative data. The elderly group had a higher conversion rate,compared to the middle-aged group,although no significant differences were observed in the surgical procedures,surgical time,intraoperative blood losses,numbers and severities of postoperative 90-day complications,postoperative90-day mortality rates,pathology results,and other short-term outcomes. Long-term follow-up revealed similar rates of recurrence,disease-free survival,and overall survival in the two groups. Multivariate analysis revealed that age did not independently predict overall survival or disease-free survival. Conclusion Similar short-and long-term outcomes were observed after LH for CRLM in elderly and middle-aged patients. Thus,advanced age is not a contraindication for LH treatment in this setting.