摘要
目的:探讨侧方淋巴结清扫术(lateral pelvic lymph node dissection,LPND)在直肠癌侧方淋巴结(lateral pelvic lymph node,LPN)转移老年患者中应用的安全性与可行性。方法:回顾性收集并分析自2012年1月至2019年12月在安阳市肿瘤医院、中国医学科学院肿瘤医院与北京大学第一医院行全直肠系膜切除术+LPND的临床怀疑LPN转移的直肠癌患者临床病理资料。以65岁为分组截断值,将所有患者分为老年组与非老年组。结果:共407例患者纳入研究,其中老年组110例,非老年组297例。老年组患者患有术前合并症的比例明显高于非老年组患者(43.6%vs 19.9%,P<0.001),同时导致了老年患者美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级较高(P=0.007)。两组患者的平均手术时间(281.3 min vs 294.1 min,P=0.291)和平均术中出血量(43.4 mL vs 36.4 mL,P=0.384)相似。术后并发症方面,两组患者的术后总体并发症发生率(33.6%vs 28.3%,P=0.294)与3-5级严重并发症发生率(10.9%vs 8.8%,P=0.507)相似,无显著统计学差异。需要注意的是,老年组患者LPND术后发生尿潴留的比例显著高于非老年组患者(18.1%vs 9.8%,P=0.020)。老年组患者术后前往ICU的比例显著高于非老年组(12.7%vs 5.4%,P=0.012)。当以ASA分级进行亚组分析,结果显示ASA分级为Ⅰ级(5.9%vs 2.9%,P=0.333)、Ⅱ级(10.0%vs 5.3%,P=0.251)与Ⅲ级(83.3%vs 57.1%,P=0.559)的老年组患者与非老年组患者术后前往ICU的比例相似,无显著统计学差异。两组患者围手术期内各有一例患者死亡。预后方面,两组患者的3年总体生存率(89.2%vs 80.9%,P=0.546)与3年无瘤生存率(76.4%vs 70.4%,P=0.346)相似,无显著统计学差异。结论:老年患者行LPND是安全可行的,但是尿潴留是其术后常见的并发症,围手术期应加强泌尿系统的重视与管理。
Objective:To investigate the safety and feasibility of lateral pelvic lymph node dissection(LPND)in elderly rectal cancer patients with lateral pelvic lymph node(LPN)metastasis.Methods:The clinicopathologic data of rectal cancer patients with suspected LPN metastasis who underwent total mesorectal excision with LPND were retrospectively analyzed from January 2012 to December 2019 in Anyang Cancer Hospital,Cancer Hospital of Chinese Academy of Medical Sciences,and Peking University First Hospital.The cut-off value was 65 years old of age,and all patients were divided into elderly and non-elderly groups.Results:A total of 407 patients were included in the study,including 110 patients in the elderly group and 297 patients in the non-elderly group.The proportion of patients with preoperative comorbidities in the elderly group was significantly higher than that in the non-elderly group(43.6%vs 19.9%,P<0.001),and it led to a higher rating of the American Society of Anesthesiologists(ASA)score in elderly patients(P=0.007).The average operation time(281.3 min vs 294.1 min,P=0.291)and average intraoperative blood loss(43.4 mL vs 36.4 mL,P=0.384)were similar between the two groups.In terms of postoperative complications,the overall incidence of postoperative complications(33.6%vs 28.3%,P=0.294)and the incidence of grade 3-5 serve complications(10.9%vs 8.8%,P=0.507)were similar between the two groups.It should be noted that the proportion of patients with urinary retention after LPND was significantly higher in the elderly group than in the non-elderly group(18.1%vs 9.8%,P=0.020).The proportion of patients in the elderly group who went to the ICU after surgery was significantly higher than that in the non-elderly group(12.7%vs 5.4%,P=0.012).When subgroup analysis was performed by ASA grade,the results showed that the proportion of patients who went to ICU after surgery with ASA grade I(5.9%vs 2.9%,P=0.333),grade II(10.0%vs 5.3%,P=0.251)and grade III(83.3%vs 57.1%,P=0.559)in elderly group was similar to that of patients in t
作者
武亚超
赵辛明
曹天明
韩晓东
李衎
黄天臣
WU Yachao;ZHAO Xinming;CAO Tianming;HAN Xiaodong;LI Kan;HUANG Tianchen(Department of General Surgery,Anyang Cancer Hospital,Henan Anyang 455000,China;Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of General Surgery,Peking University First Hospital,Beijing 100034,China)
出处
《现代肿瘤医学》
CAS
北大核心
2023年第22期4189-4193,共5页
Journal of Modern Oncology
基金
中国癌症基金会北京希望马拉松专项基金(编号:LC2020B25)。
关键词
老年患者
侧方淋巴结
侧方淋巴结清扫
安全性
生存
elderly patients
lateral pelvic lymph node
lateral pelvic lymph node dissection
safety
survival
