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Abstract：
OBJECTIVE: In the context of an increasing older population, knowing the surgical outcomes of older patients is of paramount importance to define a comprehensive strategy for colon cancer treatment in these patients. This study aimed to analyze the surgical outcomes and survival of patients over 80 years old undergoing surgery for colon cancer.
METHODS: This is an observational retrospective longitudinal study of patients over 80 years old with colon cancer diagnosis who underwent surgery for this condition, between 2018 and 2021, in a Portuguese hospital. Demographic and clinical features were characterized. Kaplan-Meier method was used for survival analysis.
RESULTS: Out of 90 patients in the study, 41.1% were female. The majority (56.7%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 1 or 0, with a median Charlson Comorbidity Index of 7.0. Tumors were primarily located in the right colon (52.2%) and sigmoid colon (25.6%), with most patients having stage II (35.6%) or stage III (25.5%) disease. Elective surgeries accounted for 73% of procedures, and 80.0% had curative intent, with laparoscopic surgery performed in 66.7% of cases. Only 8.3% of those undergoing curative-intent procedures received adjuvant chemotherapy. Emergent admissions were associated with more advanced cancer stages, higher rates of palliative intent procedures (45.8% versus 10.6%, p < 0.001), and more open surgeries (75.0% versus 9.1%, p < 0.001) when compared to elective procedures. Postoperative mortality was higher in the emergent group (20.8% versus 10.6%), though there was no association between the type of admission and postoperative complications. Median overall survival for all patients was 36.7 (95% CI 28.1 to 45.3) months, with significant differences between curative-intent and palliative surgeries (median of 39.8 (95% CI 32.6 to 47.0) versus 10.6 (95% CI 0.67 to 20.5) months, p = 0.015). The elective group of patients had significantly better overall survival compared to the emergent group (median of 36.7 (95% CI 30.7 to 42.7) versus 11.9 (95% CI 6.0 to 17.8) months, p = 0.01). Among the patients who underwent curative-intent procedures, there were no significant differences in overall or disease-free survival between elective and emergent groups.
CONCLUSIONS: Despite the increased complexity of managing older patients, particularly in emergent cases, these findings emphasize the importance of elective, curative-intent surgeries to optimize overall survival. Effective treatment strategies and perioperative management tailored to this age group are essential for improving surgical outcomes and extending survival in elderly colon cancer patients.
METHODS: This is an observational retrospective longitudinal study of patients over 80 years old with colon cancer diagnosis who underwent surgery for this condition, between 2018 and 2021, in a Portuguese hospital. Demographic and clinical features were characterized. Kaplan-Meier method was used for survival analysis.
RESULTS: Out of 90 patients in the study, 41.1% were female. The majority (56.7%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 1 or 0, with a median Charlson Comorbidity Index of 7.0. Tumors were primarily located in the right colon (52.2%) and sigmoid colon (25.6%), with most patients having stage II (35.6%) or stage III (25.5%) disease. Elective surgeries accounted for 73% of procedures, and 80.0% had curative intent, with laparoscopic surgery performed in 66.7% of cases. Only 8.3% of those undergoing curative-intent procedures received adjuvant chemotherapy. Emergent admissions were associated with more advanced cancer stages, higher rates of palliative intent procedures (45.8% versus 10.6%, p < 0.001), and more open surgeries (75.0% versus 9.1%, p < 0.001) when compared to elective procedures. Postoperative mortality was higher in the emergent group (20.8% versus 10.6%), though there was no association between the type of admission and postoperative complications. Median overall survival for all patients was 36.7 (95% CI 28.1 to 45.3) months, with significant differences between curative-intent and palliative surgeries (median of 39.8 (95% CI 32.6 to 47.0) versus 10.6 (95% CI 0.67 to 20.5) months, p = 0.015). The elective group of patients had significantly better overall survival compared to the emergent group (median of 36.7 (95% CI 30.7 to 42.7) versus 11.9 (95% CI 6.0 to 17.8) months, p = 0.01). Among the patients who underwent curative-intent procedures, there were no significant differences in overall or disease-free survival between elective and emergent groups.
CONCLUSIONS: Despite the increased complexity of managing older patients, particularly in emergent cases, these findings emphasize the importance of elective, curative-intent surgeries to optimize overall survival. Effective treatment strategies and perioperative management tailored to this age group are essential for improving surgical outcomes and extending survival in elderly colon cancer patients.
摘要：
目标：在老年人口增加的背景下，了解老年患者的手术结局对于制定针对这些患者的结肠癌综合治疗策略至关重要.本研究旨在分析80岁以上接受结肠癌手术的患者的手术效果和生存率。
方法：这是一项观察性回顾性纵向研究，对80岁以上的结肠癌诊断患者进行了手术治疗，2018年至2021年，在一家葡萄牙医院。人口统计学和临床特征进行了表征。采用Kaplan-Meier法进行生存分析。
结果：在研究的90名患者中，41.1%为女性。大多数（56.7％）的东部肿瘤协作组（ECOG）表现状态为1或0，平均Charlson合并症指数为7.0。肿瘤主要位于右半结肠(52.2%)和乙状结肠(25.6%),大多数患者患有II期（35.6％）或III期（25.5％）疾病。选择性手术占手术的73%，80.0%有治愈意图，66.7%的病例进行了腹腔镜手术。接受治愈性手术的患者中只有8.3％接受了辅助化疗。紧急入院与更晚期的癌症阶段有关，姑息意向手术的发生率更高(45.8%对10.6%，p<0.001)，和更多的开放性手术(75.0%对9.1%，与选修程序相比，p<0.001)。急诊组术后死亡率较高(20.8%对10.6%),尽管入院类型和术后并发症之间没有关联。所有患者的中位总生存期为36.7个月（95％CI28.1至45.3），治愈性手术和姑息性手术之间存在显着差异（中位数分别为39.8个月（95％CI32.6至47.0）和10.6个月（95％CI0.67至20.5），p=0.015)。与急诊组相比，择期组患者的总生存期明显优于急诊组（中位数为36.7（95％CI30.7至42.7）与11.9（95％CI6.0至17.8）个月，p=0.01)。在接受治愈性手术的患者中，择期组和急诊组的总生存期或无病生存期无显著差异.
结论：尽管老年患者管理的复杂性增加，特别是在紧急情况下，这些发现强调了选修的重要性，治愈性手术以优化总体生存率。针对该年龄组的有效治疗策略和围手术期管理对于改善老年结肠癌患者的手术结果和延长生存期至关重要。
方法：这是一项观察性回顾性纵向研究，对80岁以上的结肠癌诊断患者进行了手术治疗，2018年至2021年，在一家葡萄牙医院。人口统计学和临床特征进行了表征。采用Kaplan-Meier法进行生存分析。
结果：在研究的90名患者中，41.1%为女性。大多数（56.7％）的东部肿瘤协作组（ECOG）表现状态为1或0，平均Charlson合并症指数为7.0。肿瘤主要位于右半结肠(52.2%)和乙状结肠(25.6%),大多数患者患有II期（35.6％）或III期（25.5％）疾病。选择性手术占手术的73%，80.0%有治愈意图，66.7%的病例进行了腹腔镜手术。接受治愈性手术的患者中只有8.3％接受了辅助化疗。紧急入院与更晚期的癌症阶段有关，姑息意向手术的发生率更高(45.8%对10.6%，p<0.001)，和更多的开放性手术(75.0%对9.1%，与选修程序相比，p<0.001)。急诊组术后死亡率较高(20.8%对10.6%),尽管入院类型和术后并发症之间没有关联。所有患者的中位总生存期为36.7个月（95％CI28.1至45.3），治愈性手术和姑息性手术之间存在显着差异（中位数分别为39.8个月（95％CI32.6至47.0）和10.6个月（95％CI0.67至20.5），p=0.015)。与急诊组相比，择期组患者的总生存期明显优于急诊组（中位数为36.7（95％CI30.7至42.7）与11.9（95％CI6.0至17.8）个月，p=0.01)。在接受治愈性手术的患者中，择期组和急诊组的总生存期或无病生存期无显著差异.
结论：尽管老年患者管理的复杂性增加，特别是在紧急情况下，这些发现强调了选修的重要性，治愈性手术以优化总体生存率。针对该年龄组的有效治疗策略和围手术期管理对于改善老年结肠癌患者的手术结果和延长生存期至关重要。
