腹腔镜全结肠系膜切除术治疗老年横结肠癌的手术及生存结局

Surgical and Survival Outcomes of Laparoscopic Complete Mesocolic Excision for Transverse Colon Cancer in Elderly Patients

目的:比较腹腔镜全结肠系膜切除术治疗老年与非老年横结肠癌的手术及生存结局。方法:选择2015年1月~2017年1月24例年龄≥65岁的老年横结肠癌患者(老年组)于本院行腹腔镜全结肠系膜切除术,同期有39例年龄<65岁的横结肠癌患者(非老年组)行腹腔镜全结肠系膜切除术,比较两组患者的手术及生存结局。结果:术前一般资料方面比较,老年组患者的Charlson合并症指数(Charlson comorbidity index,CCI)为(2.62±0.82),较非老年组的(2.18±0.50)高,差异有统计学意义(P<0.05);美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级老年组较非老年组高(P<0.05)。两组患者在手术时间、术中失血量、中转率、病理结果、术后30d死亡率、术后30d并发症发生率、严重并发症发生率比较差异无统计学意义。随访期间,两组患者的复发率、5年总体生存率及5年无瘤生存率比较,差异无统计学意义。结论:老年横结肠癌患者行腹腔镜全结肠系膜切除术是安全、有效的,其手术及生存结局与非老年患者类似。

Objective:This study was designed to compare the survival and surgical outcomes of laparoscopic complete mesocolic excision in elderly and non-elderly patients with transverse colon cancer.Methods:From January 2015 to January 2017,24 elderly patients with transverse colon cancer aged≥65 years(elderly group)were selected to undergo laparoscopic total mesocolectomy at our hospital.During the same period,39 patients with transverse colon cancer aged<65 years(non elderly group)underwent laparoscopic total mesocolectomy.The survival and surgical outcomes of the two groups were compared retrospectively.Results:In terms of preoperative general information,the Charlson comorbidity index(CCI)of the elderly group was(2.62±0.82),which was higher than that of the non elderly group(2.18±0.50),and the difference was statistically significant(P<0.05);The American Society of Anesthesiologists(ASA)classified the elderly group as higher than the non elderly group(P<0.05).There was no statistically significant difference between the two groups of patients in terms of surgical time,intraoperative blood loss,conversion rate,pathological results,postoperative mortality rate at 30 days,incidence of postoperative complications at 30 days,and incidence of severe complications.During the follow-up period,there was no statistically significant difference in the recurrence rate,5-year overall survival rate,and 5-year tumor free survival rate between the two groups of patients.Conclusion:Laparoscopic total mesocolectomy is safe and effective for elderly patients with transverse colon cancer,and its surgical and survival outcomes are similar to those of non elderly patients.