Objective: To analyze the types and characteristics of post-operative complications in colorectal cancer patients aged over 85 years undergoing laparoscopic surgery, and to summarize peri-operative management strategies. Methods: This was an observational study. Inclusion criteria: pathologically confirmed adenocarcinoma; tumor located in ileocecum, ascending colon, transverse colon, descending colon, sigmoid colon, or rectum; undergoing laparoscopic radical resection for colorectal cancer; complete clinical data. Exclusion criteria included distant metastasis, synchronous resection of multiple primary cancers, simultaneous liver metastasis surgery, and follow-up duration <1 month. A retrospective analysis was conducted on 191 patients of colorectal cancer patients aged over 85 years who underwent laparoscopic radical surgery in the General Surgery Department at Peking Union Medical College Hospital from January 2019 to January 2024. Among 191 patients, 107 patients (56.0%) had colon cancer and 84 (44.0%) rectal cancer. All patients received "home-based prehabilitation" and post-operative "enhanced recovery after surgery" protocols. Patient characteristics, peri-operative complication types, treatments, and outcomes were analyzed. Results: Post-operative complications occurred in 97 patients (50.8%), including 53 colon cancer patients (54.6%) and 44 rectal cancer patients (45.4%). Comorbidities existed in 88 patients (90.7%), with 93 patients (95.9%) classified as ASA II-III pre-operatively and 86 (88.7%) having nutritional risks. Surgical procedures included Dixon procedure (38 patients, 39.2%), right hemicolectomy (33 patients, 34.0%), sigmoidectomy (10 patients, 10.3%), and 17 patients (17.5%) received prophylactic stomas. Complication types comprised non-anastomotic infections (38 patients, 19.9%), intestinal flora disorder (26 patients, 13.6%), anastomotic/wound/stoma-related complications (16 patients, 8.4%), thrombotic/hemorrhagic events (6 patients, 3.1%), and others (11 patients, 5.8%). By Clavien-Dindo classification: Grade I (12 patients, 6.3%), Grade II (69 patients, 36.1%), Grade III (12 patients, 6.3%), and Grade IV (4 patients, 2.1%). Except for 5 patients (2.6%) requiring unplanned re-operation, all complications resolved with conservative treatment. The median duration of post-operative hospitalization was 9.5 days (7-13). Conclusion: Non-anastomotic infections and intestinal flora disorder constitute predominant complications after laparoscopic surgery in colorectal cancer patients aged over 85 years, mostly manageable with conservative treatment. Strengthened peri-operative management incorporating pre-operative prehabilitation and post-operative enhanced recovery after surgery protocols is crucial for patients aged over 85 years.
目的： 分析85岁以上高龄结直肠癌患者腹腔镜手术后并发症的类型和特征，总结围手术期的管理措施。 方法： 本研究采用观察性研究方法。纳入标准：（1）肠镜病理明确的腺癌；（2）肿瘤位于回盲部、升结肠、横结肠、降结肠、乙状结肠及直肠；（3）接受腹腔镜结直肠癌根治术；病例资料完整。排除远处转移、多原发癌同期切除或肝转移瘤同期手术以及随访时间不足1月的患者。回顾性收集2019年1月至2024年1月期间，北京协和医院基本外科结直肠专业组接受腹腔镜结直肠癌根治术的85岁以上高龄患者191例，结肠癌107例（56.0%），直肠癌84例（44.0%）。所有患者术前均接受了“居家预康复”和术后“加速康复外科”围手术期管理模式；分析患者特征、围手术期并发症的类型、治疗以及预后。 结果： 全组191例85岁以上高龄结直肠癌患者中，有97例（50.8%）发生术后并发症，其中结肠癌患者53例（54.6%），直肠癌患者44例（45.4%）；高龄合并基础病者88例（90.7%）；术前美国麻醉医师协会（ASA）评级Ⅱ~Ⅲ级93例（95.9%），有86例（88.7%）存在营养风险；手术方式中，直肠癌Dixon术38例（39.2%），右半结肠切除术33例（34.0%），乙状结肠切除术10例（10.3%），有17例（17.5%）进行了预防性造口。全组191例患者术后并发症发生情况：非吻合口相关感染并发症38例（19.9%），肠道菌群失调26例（13.6%），吻合口、切口和造口并发症16例（8.4%），血栓和出血性并发症6例（3.1%），其他类型并发症11例（5.8%）；并发症Ciavien-Dindo分级，Ⅰ级12例（6.3%），Ⅱ级69例（36.1%），Ⅲ级12例（6.3%），Ⅳ级4例（2.1%）。对出现并发症患者除5例（2.6%）进行了非计划再次手术外，其余患者均经保守治疗治愈。术后全组中位住院时间9.5（7~13）d。 结论： 85岁以上高龄结直肠癌患者腹腔镜手术后的并发症以非吻合口相关感染和肠道菌群失调为主，经保守治疗多可治愈；应对老年患者加强围手术期管理（包括术前预康复和术后加速康复）。.