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[Effect of chemotherapy preoperatively upon early postoperative cognitive dysfunction in eldly tumor patients].

OBJECTIVE
To investigate whether preoperative chemotherapy history could influence the incidence of early postoperative cognitive dysfunction (POCD) in elderly tumor patients.


METHODS
A total of 107 tumor patients (> or = 60 years old, tumor TNM stages T2 - T3, N0 - N3, ASA I -III class) undergoing elective radical surgery of gastric or colorectal cancer were selected and assigned into two groups according to preoperative chemotherapy history: with preoperative chemotherapy history group (C group, n = 52) and without preoperative chemotherapy history group (N group, n = 55). Patients in two groups received radical surgery under intravenous-inhalation general anesthesia combined with epidural anesthesia. Cognitive function was assessed using a battery of neuropsychological tests from five aspects including memory, verbal intelligence, visual-motor, executive function and motor function at 1 day preoperatively and 3 days postoperatively.


RESULTS
There was no significant difference in general state of patient preoperatively health including sex ratio, body mass index, complications, cancer types and stages, ASA classification between two groups (P > 0.05). Neither significant difference was found in duration of anesthesia and surgery, intra-operative bleeding volume and transfusion volume between two groups (P > 0.05). There was no significant difference in ICU admission rate, ICU stay, incidence of complications, hospitalization duration and mortality rate between two groups (P > 0.05). Preoperative neuropsychological test score in group C was slightly lower than that in group N, but the difference was not significant (P > 0.05). Impaired incidence rate of digit-symbol substitution test, controlled oral word association test, grooved pegboard non-dominant hand test and semantic fluency test at 3 days postoperation in group C were significantly higher than those in N group (P < 0.05). Incidence of POCD at 3 days postoperation in group C was significantly higher than that in group N (42.3% vs 15.4% , P < 0.05).


CONCLUSION
Chemotherapy preoperatively could increase the incidence of early postoperative cognitive dysfunction in elderly with tumor.