medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-21-2-72-79medsovet-6637Research ArticleОнкологияOncologyГериатрический подход в лечении пациентов старческого возраста с колоректальным ракомGeriatric approach to the treatment of senile patients with colorectal cancerhttps://orcid.org/0000-0002-3192-3786НековальВ. М.NekovalV. M.

Нековаль Валерий Михайлович - врач-колопроктолог, онколог клиники колопроктологии и малоинвазивной хирургии.

119991, Москва, ул. Трубецкая, д. 8, стр. 2.

Valery M. Nekoval - Colorectal Surgeon of the Clinic of Coloproctology and Minimally Invasive Surgery, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991.

nekoval@kkmx.ruhttps://orcid.org/0000-0003-0283-2217ЕфетовС. К.EfetovS. K.

Ефетов Сергей Константинович – кандидат медицинских наук, заведующий отделением колопроктологии клиники колопроктологии и малоинвазивной хирургии, доцент кафедры хирургии, Институт клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2.

Sergey K. Efetov - Cand. Sci. (Med.), Colorectal Surgeon of the Clinic of Coloproctology and Minimally Invasive Surgery, Associate Professor of the Department of Surgery of Sklifosovsky Clinical Medicine Institute, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991.

efetov@kkmx.ruhttps://orcid.org/0000-0002-7134-6821ЦарьковП. В.TsarkovP. V.

Царьков Петр Владимирович – доктор медицинских наук, профессор, директор клиники колопроктологии и малоинвазивной хирургии, заведующий кафедрой хирургии, Институт клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2.

Petr V. Tsarkov - Dr. Sci. (Med.), Professor, Head of the Clinic of Coloproctology and Minimally Invasive Surgery, Head of the Department of Surgery of Sklifosovsky Clinical Medicine Institute, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991.

tsarkov@kkmx.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202108012022021-27279Copyright © Нековаль В.М., Ефетов С.К., Царьков П.В., 20222022Нековаль В.М., Ефетов С.К., Царьков П.В.Nekoval V.M., Efetov S.K., Tsarkov P.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6637Введение

Введение. Отсутствие единых рекомендаций по лечению колоректального рака (КРР) у пациентов старческого возраста, высокая частота ранних послеоперационных осложнений при выполнении радикальных операций являются причинами поиска наиболее оптимального подхода к тактике ведения данной категории пациентов.

Цель исследования – ввести гериатрический подход к лечению колоректального рака у пациентов старческого возраста, снизить частоту ранних послеоперационных осложнений 4-й категории по классификации Clavien-Dindo.

Материалы и методы

Материалы и методы. В исследование были включены 190 пациентов старческого возраста с колоректальным раком II и III стадий, прооперированных в радикальном объеме с лимфодиссекцией в объеме D3. Были сформированы 2 группы: в контрольную группу вошли 100 пациентов, прошедших лечение в стандартном объеме, в исследуемую группу включены 90 больных, к которым был применен гериатрический подход с проведением комплексной гериатрической оценки и последующей преабилитацией. На основании полученных данных был проведен сравнительный межгрупповой анализ.

Результаты

Результаты. Исследуемая группа отличалась более высокой полиморбидностью и высоким операционно-анестезиологическим риском по сравнению с контрольной группой (p < 0,001). Проведение гериатрической преабилитации с учетом данных КГО и коррекция полиморбидности расширили возможности оказания хирургической помощи с применением лапароскопических и роботических технологий. Была снижена частота интраоперационной гемотрансфузии и продленной ИВЛ в исследуемой группе (p < 0,001 и р = 0,009 соответственно). Выявлены предикторы, увеличивающие шансы развития острого послеоперационного инфаркта миокарда. В их число вошли принадлежность пациента к мужскому полу (р = 0,004), повторные операции при развитии ранних послеоперационных осложнений (р = 0,043), продленная ИВЛ (р = 0,052), увеличение длительности пребывания пациента в отделении реанимации (р = 0,011) и коморбидность (р = 0,022). Введение гериатрического подхода позволило снизить риск развития послеоперационного инфаркта миокарда в 17,86 раза (р = 0,007).

Выводы

Выводы. Гериатрический подход к пациентам старческого возраста с КРР позволяет расширить показания для радикального лечения при выраженной полиморбидности и старческой астении, а также снизить частоту ранних послеоперационных осложнений.

Introduction

Introduction. The lack of consensus guidelines for the treatment of colorectal cancer (CRC) in senile patients, the high incidence of early postoperative complications after radical surgery caused the search for the most optimal approach to the management of this category of patients.

The aim is to introduce a geriatric approach to the treatment of colorectal cancer in senile patients, reduce the incidence of Clavien–Dindo grade 4 early postoperative complications.

Materials and methods

Materials and methods. 190 senile patients who underwent radical surgery with D3 lymphadenectomy with stage II and III colorectal cancer were enrolled in the study. They were divided into two groups: the control group included 100 patients who underwent standard treatment, the study group included 90 patients, to whom the geriatric approach with a comprehensive geriatric assessment (CGA) and subsequent pre-rehabilitation was applied. A comparative intergroup analysis was performed on the basis of obtained data.

Results

Results. The study group differed from the control group in higher polymorbidity and high operational and anesthetic risk (p <0.001). Implementation of geriatric pre-rehabilitation with due account for CGA results and correction of polymorbidity improved chances of providing surgical care using laparoscopic and robotic technologies. The frequency of intraoperative blood transfusion and prolonged mechanical ventilation in the study group was reduced (p <0.001 and p = 0.009, respectively). Predictors that increase the chances of developing acute postoperative myocardial infarction were identified. They included the patient’s male gender (p = 0.004), redo surgery after development of early postoperative complications (p = 0.043), prolonged mechanical ventilation (p = 0.052), increased length of stay in the intensive care unit (p = 0.011), and comorbidity (p = 0.022). The introduction of the geriatric approach made it possible to reduce the risk of postoperative myocardial infarction by 17.86 times (p = 0.007).

Conclusion

Conclusion. The geriatric approach to the senile patients with colorectal cancer makes it possible to expand the indications for radical treatment in severe polymorbidity and senile asthenia, as well as to reduce the incidence of early postoperative complications.

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The authors declare that there are no conflicts of interest present.