Feasibility of Colorectal Endoscopic Submucosal Dissection in Elderly Patients: The Impact of Sarcopenia.

IF 3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Digestion Pub Date : 2024-01-01 Epub Date: 2024-01-17 DOI:10.1159/000536267
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Abstract

Introduction: Colorectal cancer is a public health concern associated with high incidence rates. Sarcopenia is a known risk factor for postoperative complications, although an association between increased complications after colorectal endoscopic submucosal dissection (ESD) and sarcopenia remains undocumented. Herein, we aimed to explore the feasibility of colorectal ESD in patients with sarcopenia.

Methods: This retrospective study included 499 patients (69 with and 430 without sarcopenia). We evaluated the short- and long-term outcomes of colorectal ESD.

Results: There were no significant differences between the two groups regarding en bloc, R0, or curative resection rates. However, poor bowel preparation was significantly more common in the sarcopenia group. Moreover, patients with sarcopenia exhibited a significant increase in complications (37.7% vs. 10.5%). Multivariate analysis revealed that sarcopenia (odds ratio [OR]: 3.78, 95% confidence interval [Cl]: 1.85-7.73, p < 0.001), anticoagulation therapy (OR: 3.59, 95% Cl: 1.86-6.92, p < 0.001), procedure time (OR: 1.28, 95% Cl: 1.11-1.47, p < 0.001), and resection size (OR: 1.25, 95% Cl: 1.03-1.52, p = 0.02) were significantly correlated with the Common Terminology Criteria for Adverse Events (CTCAE) ≥ grade 2. The correlation between sarcopenia and CTCAE ≥ grade 2 was maintained after matching, resulting in more extended hospital stays in patients with sarcopenia. However, we detected no association between sarcopenia and overall survival and ESD-related death.

Conclusion: Sarcopenia is a risk factor for complications in colorectal ESD, suggesting that colorectal ESD could be performed for patients with sarcopenia, although much caution should be taken.

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老年患者结直肠内镜黏膜下剥离术的可行性:肌肉疏松症的影响。
简介结肠直肠癌(CRC)发病率高,是一个公共卫生问题。已知肌肉疏松症是导致术后并发症的风险因素之一,但结肠直肠镜黏膜下剥离术(ESD)后并发症的增加与肌肉疏松症之间的关系仍未得到证实。在此,我们旨在探讨对肌肉疏松症患者进行结直肠ESD的可行性:这项回顾性研究纳入了 499 名患者(69 名患有肌肉疏松症,430 名不患有肌肉疏松症)。我们评估了结肠直肠ESD的短期和长期疗效:结果:两组患者在全切、R0 或根治性切除率方面无明显差异。但在肌肉疏松症组中,肠道准备不充分的情况明显更常见。此外,肌肉疏松症患者的并发症明显增加(37.7% 对 10.5%)。多变量分析显示,肌肉疏松症(几率比[OR] 3.78,95% 置信区间[Cl] 1.85-7.73,P < 0.001)、抗凝治疗(OR 3.59,95% Cl 1.86-6.92,P < 0.001)、手术时间(OR 1.28,95% Cl 1.11-1.47,p < 0.001)和切除大小(OR 1.25,95% Cl 1.03-1.52,p = 0.02)与不良事件通用术语标准(CTCAE)≥2级显著相关。肌肉疏松症与 CTCAE ≥ 2 级之间的相关性在匹配后仍然存在,这导致肌肉疏松症患者的住院时间更长。然而,我们并未发现肌肉疏松症与总生存率和ESD相关死亡之间存在关联:结论:肌肉疏松症是导致结肠直肠ESD并发症的一个危险因素,这表明可以对患有肌肉疏松症的患者进行结肠直肠ESD手术,但仍需谨慎。
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来源期刊
Digestion
Digestion 医学-胃肠肝病学
CiteScore
7.90
自引率
0.00%
发文量
39
审稿时长
6-12 weeks
期刊介绍: ''Digestion'' concentrates on clinical research reports: in addition to editorials and reviews, the journal features sections on Stomach/Esophagus, Bowel, Neuro-Gastroenterology, Liver/Bile, Pancreas, Metabolism/Nutrition and Gastrointestinal Oncology. Papers cover physiology in humans, metabolic studies and clinical work on the etiology, diagnosis, and therapy of human diseases. It is thus especially cut out for gastroenterologists employed in hospitals and outpatient units. Moreover, the journal''s coverage of studies on the metabolism and effects of therapeutic drugs carries considerable value for clinicians and investigators beyond the immediate field of gastroenterology.
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