岁以上高龄结直肠癌患者腹腔镜与开腹 手术的近期疗效与远. (Chinese)

Objective To examine short-term outcomes and long-term survival of elderly patients (aged over 80 years) with colorectal cancer who received laparoscopic versus open surgery. Methods A total of 313 patients over 80 years old with colorectal cancer who underwent radical surgery were included. According to the surgical method, all patients were divided into open-surgery group (n=143) and laparoscopic surgery group(n=170). Baseline data were balanced between the two groups by using propensity score matching. Kaplan-Meier was used to draw the survival curve, and survival was compared by Log rank tests. Cox proportional risk model was used to analyze the effects of all factors on overall survival (OS) and disease-free survival (DFS). Results After matching, 93 patients were included in each group. The mean intraoperative blood loss, the incidence of overall postoperative complications and gradeⅠ-Ⅱ complications in the laparoscopic surgery group were significantly lower than those in the open surgery group (all P<0.05). The time to first flatus, the time to oral feeding, and postoperative hospital stays in the laparoscopic surgery group were significantly shorter than those in the open surgery group (all P<0.05). The mean number of lymph-node dissection was also significantly higher in the laparoscopic surgery group than in the open surgery group (P=0.030). Patients in both groups had similar 5-year OS (P=0.594) and DFS (P=0.295). Multivariate Cox prognostic analysis showed that CEA level >5 ng/ml, pathological TNM stage Ⅲ, and perineural invasion were independent risk factors for poor OS and DFS. Conclusion Compared with open surgery, laparoscopic surgery can provide better short-term advantages and similar long-term outcomes for colorectal cancer patients over 80 years of age. [ABSTRACT FROM AUTHOR]

目的 探讨80岁以上高龄结直肠癌患者行腹腔镜与开腹手术的近期疗效与远期预后。方法 纳入行根治性手术的80岁以上313例高龄结直肠癌患者，其中开腹组143例、腹腔镜组170例。采用倾向得分匹配平衡两组患者基线资料。Kaplan-Meier绘制生存曲线，Log rank法进行预后比较。Cox比例风险模型分析各因素对总体生存率（OS）和无瘤生存率（DFS）的影响。结果 匹配后，两组各纳入93例患者。腹腔镜组患者平均术中出血量、术后总体并发症与Ⅰ～Ⅱ级并发症发生率低于开腹组（均P＜0.05）、术后首次排气时间、经口进食时间与住院时间均明显短于开腹组患者（均P＜0.05）、平均淋巴结清扫数量显著多于开腹组（P=0.030）。两组患者有着相似的5年OS（P=0.594）与DFS（P=0.295）。多因素Cox预后分析结果发现CEA水平＞5ng/ml、病理TNM分期Ⅲ期与神经侵犯是影响患者不良OS与DFS的独立危险因素。结论 与开腹手术相比，腹腔镜手术可以为80岁以上高龄结直肠癌患者提供更好的短期治疗效果与相似的远期预后。 [ABSTRACT FROM AUTHOR]

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