J.C. Le Néel, P. Lasserre, E. Letessier, F. Jurczak, P. Bernard, C. Mauchien, O. Armstrong
{"title":"75年后绞痛的手术治疗。240例患者的研究*","authors":"J.C. Le Néel, P. Lasserre, E. Letessier, F. Jurczak, P. Bernard, C. Mauchien, O. Armstrong","doi":"10.1016/S0001-4001(99)00084-7","DOIUrl":null,"url":null,"abstract":"<div><p>Surgery for large bowel cancer in patients over 75 years of age. (240 cases).</p><p>Aim of the study: The aim of this retrospective study was to report the results of the surgical treatment for large bowel cancer in patients over 75 years of age.</p><p>Patients and method: From 1985 to 1996, 240 patients, 114 men and 126 women, aged 75 years or over (mean age: 82, range: 75 to 95 years) underwent surgical treatment for large bowel carcinoma. Tumors were located in the right colon (n=120), left colon (n=100), transverse colon (n=5), or were multiple (n=15). Clinical presentation was failure of general condition (25%), intestinal obstruction (20%), rectal bleeding (20%), abdominal pain (17%). ASA score was I (n=1), II (n=69), III (n=134), or IV (n=36). Emergency surgery was mandatory in 110 cases (43 urgent and 67 delayed procedures) and 130 patients underwent elective surgery. Surgical resection was performed in 221 cases, including 177 cases with curative intent (67%). Surgical procedures included right colectomy (n=119), left colectomy (n=59), transverse colectomy (n=9) or subtotal colectomy (n=31). Histopathological staging was Astler - Coller A (n=8), B (n=116), C (n=54) et D (n=62).</p><p>Results: The postoperative course was uneventful in 157 cases (65.4%). Medical complications occurred in 46 patients with 34 deaths; and surgical complications in 39 patients with 20 subsequent reoperations and 15 deaths. The overall postoperative mortality rate was 20.4% (n=49). Postoperative mortality rate was higher after emergency operations (32.7% vs 10%), higher with the level of ASA grading (class II: 8.6%, Class III: 17.1%, Class IV: 38.8%), higher in patients over 90 years (37.4% vs. 19.1%) and in patients wihout surgical resection (42% vs 18.5%). Disease specific 5-year survival rate was 45% and did not differ when compared to patients younger than 75 years (42%, data not reported).</p><p>Conclusions: Patients older than 75 years remain a high risk group, specially if operated on emergency. Nevertheless, age is not a limiting factor in the surgical treatment of colon cancer. Prognosis is mostly depending on ASA grading. Colectomy with curative intent has to be performed when possible.</p></div>","PeriodicalId":29786,"journal":{"name":"Chirurgie","volume":"124 6","pages":"Pages 670-674"},"PeriodicalIF":0.6000,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0001-4001(99)00084-7","citationCount":"4","resultStr":"{\"title\":\"Traitement chirurgical des cancers coliques après 75 ans. Étude d'une série de 240 patients*\",\"authors\":\"J.C. Le Néel, P. Lasserre, E. Letessier, F. Jurczak, P. Bernard, C. Mauchien, O. Armstrong\",\"doi\":\"10.1016/S0001-4001(99)00084-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>Surgery for large bowel cancer in patients over 75 years of age. (240 cases).</p><p>Aim of the study: The aim of this retrospective study was to report the results of the surgical treatment for large bowel cancer in patients over 75 years of age.</p><p>Patients and method: From 1985 to 1996, 240 patients, 114 men and 126 women, aged 75 years or over (mean age: 82, range: 75 to 95 years) underwent surgical treatment for large bowel carcinoma. Tumors were located in the right colon (n=120), left colon (n=100), transverse colon (n=5), or were multiple (n=15). Clinical presentation was failure of general condition (25%), intestinal obstruction (20%), rectal bleeding (20%), abdominal pain (17%). ASA score was I (n=1), II (n=69), III (n=134), or IV (n=36). Emergency surgery was mandatory in 110 cases (43 urgent and 67 delayed procedures) and 130 patients underwent elective surgery. Surgical resection was performed in 221 cases, including 177 cases with curative intent (67%). Surgical procedures included right colectomy (n=119), left colectomy (n=59), transverse colectomy (n=9) or subtotal colectomy (n=31). Histopathological staging was Astler - Coller A (n=8), B (n=116), C (n=54) et D (n=62).</p><p>Results: The postoperative course was uneventful in 157 cases (65.4%). Medical complications occurred in 46 patients with 34 deaths; and surgical complications in 39 patients with 20 subsequent reoperations and 15 deaths. The overall postoperative mortality rate was 20.4% (n=49). Postoperative mortality rate was higher after emergency operations (32.7% vs 10%), higher with the level of ASA grading (class II: 8.6%, Class III: 17.1%, Class IV: 38.8%), higher in patients over 90 years (37.4% vs. 19.1%) and in patients wihout surgical resection (42% vs 18.5%). Disease specific 5-year survival rate was 45% and did not differ when compared to patients younger than 75 years (42%, data not reported).</p><p>Conclusions: Patients older than 75 years remain a high risk group, specially if operated on emergency. Nevertheless, age is not a limiting factor in the surgical treatment of colon cancer. Prognosis is mostly depending on ASA grading. Colectomy with curative intent has to be performed when possible.</p></div>\",\"PeriodicalId\":29786,\"journal\":{\"name\":\"Chirurgie\",\"volume\":\"124 6\",\"pages\":\"Pages 670-674\"},\"PeriodicalIF\":0.6000,\"publicationDate\":\"1999-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/S0001-4001(99)00084-7\",\"citationCount\":\"4\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chirurgie\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0001400199000847\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chirurgie","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0001400199000847","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 4
摘要
75岁以上大肠癌患者的手术治疗。(240例)。研究目的:本回顾性研究的目的是报道75岁以上大肠癌患者手术治疗的结果。患者和方法:1985 - 1996年，240例大肠癌患者接受手术治疗，其中男性114例，女性126例，年龄75岁及以上(平均年龄82岁，范围75 - 95岁)。肿瘤位于右结肠(n=120)、左结肠(n=100)、横结肠(n=5)或多发(n=15)。临床表现为一般情况不佳(25%)，肠梗阻(20%)，直肠出血(20%)，腹痛(17%)。ASA评分为I (n=1)、II (n=69)、III (n=134)、IV (n=36)。110例患者必须接受紧急手术(43例紧急手术，67例延迟手术)，130例患者接受了选择性手术。手术切除221例，其中有治愈目的的177例(67%)。手术包括右结肠切除术(119例)、左结肠切除术(59例)、横结肠切除术(9例)或结肠次全切除术(31例)。组织病理学分期为Astler - Coller A (n=8)、B (n=116)、C (n=54)、D (n=62)。结果:157例(65.4%)手术过程顺利。发生医疗并发症46例，死亡34例;39例患者出现手术并发症，20例再次手术，15例死亡。术后总死亡率为20.4% (n=49)。急诊手术后死亡率较高(32.7% vs 10%)， ASA分级水平较高(II级:8.6%，III级:17.1%，IV级:38.8%)，90岁以上患者死亡率较高(37.4% vs 19.1%)，未手术切除患者死亡率较高(42% vs 18.5%)。疾病特异性5年生存率为45%，与75岁以下患者相比无差异(42%，数据未报道)。结论:75岁以上患者仍是高危人群，特别是急诊手术患者。然而，年龄并不是结肠癌手术治疗的限制因素。预后主要取决于ASA分级。有治疗目的的结肠切除术必须尽可能进行。
Traitement chirurgical des cancers coliques après 75 ans. Étude d'une série de 240 patients*
Surgery for large bowel cancer in patients over 75 years of age. (240 cases).
Aim of the study: The aim of this retrospective study was to report the results of the surgical treatment for large bowel cancer in patients over 75 years of age.
Patients and method: From 1985 to 1996, 240 patients, 114 men and 126 women, aged 75 years or over (mean age: 82, range: 75 to 95 years) underwent surgical treatment for large bowel carcinoma. Tumors were located in the right colon (n=120), left colon (n=100), transverse colon (n=5), or were multiple (n=15). Clinical presentation was failure of general condition (25%), intestinal obstruction (20%), rectal bleeding (20%), abdominal pain (17%). ASA score was I (n=1), II (n=69), III (n=134), or IV (n=36). Emergency surgery was mandatory in 110 cases (43 urgent and 67 delayed procedures) and 130 patients underwent elective surgery. Surgical resection was performed in 221 cases, including 177 cases with curative intent (67%). Surgical procedures included right colectomy (n=119), left colectomy (n=59), transverse colectomy (n=9) or subtotal colectomy (n=31). Histopathological staging was Astler - Coller A (n=8), B (n=116), C (n=54) et D (n=62).
Results: The postoperative course was uneventful in 157 cases (65.4%). Medical complications occurred in 46 patients with 34 deaths; and surgical complications in 39 patients with 20 subsequent reoperations and 15 deaths. The overall postoperative mortality rate was 20.4% (n=49). Postoperative mortality rate was higher after emergency operations (32.7% vs 10%), higher with the level of ASA grading (class II: 8.6%, Class III: 17.1%, Class IV: 38.8%), higher in patients over 90 years (37.4% vs. 19.1%) and in patients wihout surgical resection (42% vs 18.5%). Disease specific 5-year survival rate was 45% and did not differ when compared to patients younger than 75 years (42%, data not reported).
Conclusions: Patients older than 75 years remain a high risk group, specially if operated on emergency. Nevertheless, age is not a limiting factor in the surgical treatment of colon cancer. Prognosis is mostly depending on ASA grading. Colectomy with curative intent has to be performed when possible.
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