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Chen B, Yu W, Ma Y, Xu P, Yao Q, Sun Q, Ren J, Wang D. Evaluation of the safety and efficacy of perform enterectomy in colorectal cancer patients aged 80 or older. A meta-analysis and a systematic review. Int J Colorectal Dis 2023; 38:185. [PMID: 37395836 DOI: 10.1007/s00384-023-04461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the four most common cancers in the world. At present, human beings have stepped into an aging society, and the number of over eighties colorectal cancer patients has increased year by year. However, few high-quality studies focused on the post-operation complications and long-term outcomes of octogenarian patients with colorectal cancer. This meta-analysis, based on published studies, aims to assess the safety of treating octogenarian CRC patients with surgery. METHODS Databases, including PubMed, Embase, and Cochrane Library were searched until July 2022. The incidence of preoperative comorbidities, postoperative complications, and mortality was assessed using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Furthermore, the hazard ratios (HRs) with 95% CIs were applied for survival outcomes. RESULTS A total of 13,790 patients with CRC in 21 studies were included. Our results demonstrated that octogenarian patients were associated with a higher burden of comorbidities (OR = 3.03; 95% CI: 2.03, 4.53; P = .000), high incidences of overall postoperative complications (OR = 1.63; 95% CI: 1.29, 2.06; P = .000), high internal medicine postoperative complications (OR = 2.38; 95% CI: 1.76, 3.21; P = .000), high in-hospital mortality (OR = 4.01; 95% CI: 3.06, 5.27; P = .000) and poor overall survival (OR = 2.13; 95% CI: 1.78, 2.55; P = .000). But there is no statistical difference in surgery-related postoperative complications(OR = 1.16; 95% CI: 0.94, 1.43; P = .16) and DFS (OR = 1.03; 95% CI: 0.83, 1.29; P = .775). CONCLUSIONS Extremely elderly patients with colorectal cancer have the high burden of comorbidities, high postoperative complications and mortality. However, survival outcomes (DFS) in patients 80 years and older are similar to younger patients. Clinicians should administer individualized treatment for such patients. Physiologic age rather than chronological age should determine cancer management for each individual.
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Affiliation(s)
- Bangquan Chen
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wenhao Yu
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Yue Ma
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- Nanjing University, Nanjing, 210093, China
- North Jiangsu People's Hospital, Nanjing University School of Medicine, Yangzhou, 225001, China
| | - Peirong Xu
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- School of Nursing, Yangzhou University, Yangzhou, 225001, China
| | - Qing Yao
- Dalian Medical University, Dalian, 116044, China
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Qiannan Sun
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Jun Ren
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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Tidadini F, Trilling B, Quesada JL, Foote A, Sage PY, Bonne A, Arvieux C, Faucheron JL. Association between Enhanced Recovery After Surgery (ERAS) protocol, risk factors and 3-year survival after colorectal surgery for cancer in the elderly. Aging Clin Exp Res 2023; 35:167-175. [PMID: 36306111 DOI: 10.1007/s40520-022-02270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/26/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION As life expectancy is currently growing, more elderly and fragile patients need colorectal resection for cancer. We sought to assess the link between enhanced rehabilitation after surgery (ERAS), risk factors and overall survival at 3 years, in patients aged 65 and over. METHODS Between 2005 and 2017, all patients undergoing colorectal resection for cancer were included. Overall survival at 3 years was compared for patients treated in following ERAS guidelines compared to conventional treatment (pre-ERAS). RESULTS 661 patients were included (ERAS, n = 325; pre-ERAS, n = 336). The 3-year overall survival rate was significantly better regardless of age for ERAS vs pre-ERAS patients (73.1% vs 64.4%; p = 0.016). With overall survival rates of 83.2% vs 73.8%, 65.4% vs 62.8% and 59.6% vs 40% for the age bands 65-74, 75-84 and ≥ 85 years. The analysis of survival at 3 years by a multivariate Cox model identified ERAS as a protective factor with a reduction in the risk of death of 30% (HR = 0.70 [0.50-0.94], p = 0017) independently of other identified risk factors: age bands, ASA score > 2, smoking, atrial fibrillation and abdominal surgery. This result is confirmed by an analysis of the propensity score (HR = 0.67 [0.47-0.97], p = 0.032). CONCLUSIONS Our study shows that ERAS is associated with better 3-year survival in patients undergoing colorectal resection for cancer, independent of risk factors. The practice of ERAS is effective and should be offered to patients aged 65 and over.
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Affiliation(s)
- Fatah Tidadini
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Bertrand Trilling
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France
| | - Jean-Louis Quesada
- Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
| | - Alison Foote
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierre-Yves Sage
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Aline Bonne
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Catherine Arvieux
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France.,Lyon Center for Innovation in Cancer, EA 3738, Lyon 1 University, Lyon, France
| | - Jean-Luc Faucheron
- Department of Digestive and Emergency Surgery, Grenoble Alpes University Hospital, Grenoble, France. .,University Grenoble Alpes, UMR 5525, CNRS, TIMC-IMAG, Grenoble, France.
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Labiad C, Chafai N. [Medical oncological treatment of colorectal cancer in the elderly]. SOINS. GERONTOLOGIE 2022; 27:20-22. [PMID: 35393031 DOI: 10.1016/j.sger.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Approximately a quarter of patients undergoing colorectal cancer surgery are over 75 years of age. Their care must therefore be adapted to minimise his functional consequences, which can be more significant in an elderly patient.
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Affiliation(s)
- Camélia Labiad
- Service de chirurgie générale et digestive, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184 rue Faubourg-Saint-Antoine, 75012 Paris, France
| | - Najim Chafai
- Service de chirurgie générale et digestive, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184 rue Faubourg-Saint-Antoine, 75012 Paris, France.
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Ogata T, Yoshida N, Sadakari Y, Iwanaga A, Nakane H, Okawara K, Endo K, Kaneshiro K, Hirokata G, Aoyagi T, Shima H, Taniguchi M. Colorectal cancer surgery in elderly patients 80 years and older: a comparison with younger age groups. J Gastrointest Oncol 2022; 13:137-148. [PMID: 35284116 PMCID: PMC8899744 DOI: 10.21037/jgo-21-627] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/11/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND A reduction in complications and mortality can be observed over the last few decades among elderly patients in the early postoperative period for colorectal cancer (CRC) surgery, but long-term outcomes are largely unknown. This study aimed to investigate the long-term outcomes of elderly patients 80 years and older after CRC surgery in comparison with younger age groups. The influence of clinical, oncological, and physical parameters on outcome were retrospectively analyzed. METHODS A total of 346 patients underwent CRC surgery with curative intent between January 2013 and December 2017. Patients were divided into three age groups: younger than 60 (n=47), between 60 and 79 (n=218), and 80 and older (n=81). Clinicopathological variables including comorbidity, modified frailty index, prognostic nutrition index (PNI), operative/postoperative data, and outcome including cause of death were compared among age groups. To identify factors associated with death from CRC and other causes, univariate and multivariate analyses using the Cox proportional hazards model were performed. RESULTS Immediate postoperative morbidity of patients with Clavien-Dindo grades of III or greater (16.0%) and the 30-day mortality rate (2.5%) of patients 80 years and older were not statistically different from those of younger age groups. Long-term disease-free survival was also similar among age groups, suggesting CRC surgery provides oncological benefit to patients irrespective of age. Multivariate analysis revealed that R1 resection, advanced tumor stage, carcinoembryonic antigen (CEA) level of >5 ng/mL, undifferentiated tumor, and longer postoperative hospital stay were risk factors for CRC death. Long-term overall survival was significantly reduced in comparison to younger age groups. Seventy percent of deaths in elderly patients during follow-up were primarily from respiratory failure and cardiovascular disease. Multivariate analysis demonstrated that advanced age, frailty, low PNI, and open procedure were risk factors for other causes of mortality. CONCLUSIONS Elderly patients undergoing CRC surgery appeared to enjoy similar oncological benefits as younger age groups. Since both modified frailty index and PNI were correlated with mortality unrelated to CRC, preoperative assessment of these factors can be important for predicting outcome and selecting patients for prehabilitation.
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Affiliation(s)
- Toshiro Ogata
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Naohiro Yoshida
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | | | - Ayako Iwanaga
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Hiroyuki Nakane
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Kazuma Okawara
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Kayoko Endo
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | | | - Gentaro Hirokata
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Takeshi Aoyagi
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
| | - Hiroji Shima
- Department of Surgery, St. Mary's Hospital, Kurume, Fukuoka, Japan
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Damasceno AM, Kesley R, Paolino BS, Dos Santos do Amaral MR, Pitombo MB. Perioperative score for octogenarian patients eligible for rectal cancer surgery. J Surg Oncol 2021; 124:1409-1416. [PMID: 34363616 DOI: 10.1002/jso.26634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/08/2021] [Accepted: 07/29/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Colorectal cancer incidence increases with age; therefore, rectal cancer treatment in elderly patients is increasingly common. Surgery is a common rectal cancer treatment, and the risks involve complicated surgical decisions. There are currently few surgical outcome data for rectal cancer in elderly patients. The aim of this study is to identify new perioperative risk factors that could be associated with higher 30- and 180-day mortality in elderly patients in good clinical condition considering traditional perioperative risk scores and to develop a risk score. METHODS A single-centre, retrospective cohort study was performed by reviewing the medical records of patients from the National Cancer Institute of Brazil aged 80 years or older who electively underwent rectal cancer surgery; several independent variables correlated with death from all causes at 30 and 180 days were studied. RESULTS Multivariate analysis found new variables (CEA, albumin and reoperation) that had independent correlations with increased 30- and 180-day mortality. A clinical risk score was developed with survival profiles ranging from 29.3% to 97.2% within 30 days and 2.45% to 91.8% within 180 days. CONCLUSIONS This score can aid in deciding whether a patient should undergo rectal cancer surgery.
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Affiliation(s)
- Arthur Mota Damasceno
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rubens Kesley
- Department of Abdominal Surgery, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Souza Paolino
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Rubens Dos Santos do Amaral
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcos Bettini Pitombo
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
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Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116072. [PMID: 34199923 PMCID: PMC8200127 DOI: 10.3390/ijerph18116072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 12/24/2022]
Abstract
Six out of every 10 new colorectal cancer (CRC) diagnoses are in people over 65 years of age. Current standardized surgical approaches have proved to be tolerable on the elderly population, although post-operative complications are more frequent than in the younger CRC population. Frailty is common in elderly CRC patients with surgical indication, and it appears to be also associated with an increase of post-operative complications. Fast-track pathways have been developed to assure and adequate post-operative recovery, but comprehensive geriatric assessments (CGA) are still rare among the preoperative evaluation of elderly CRC patients. This review provides a thorough study of the effects that a CGA assessment and a geriatric intervention have in the prognosis of CRC elderly patients with surgical indication.
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Kang GE, Naik AD, Ghanta RK, Rosengart TK, Najafi B. A Wrist-Worn Sensor-Derived Frailty Index Based on an Upper-Extremity Functional Test in Predicting Functional Mobility in Older Adults. Gerontology 2021; 67:753-761. [PMID: 33794537 DOI: 10.1159/000515078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Preoperative frailty is an independent risk factor for postoperative complications across surgical specialties. Functional mobility such as gait, timed up and go (TUG), and 5 times sit-to-stand (5-STS) are popular preoperative frailty measurements but are not suitable for patients with severe mobility impairment. A wrist-worn sensor-derived frailty index based on an upper-extremity functional test (20-s repetitive elbow flexion-extension task; UEFI) was developed previously; however, its association with functional mobility remained unexplored. We aimed to investigate the predictive power of the UEFI in predicting functional mobility. METHODS We examined correlation between the UEFI and gait speed, TUG duration, and 5-STS duration in 100 older adults (≥ 65 years) using multivariate regression analysis. The UEFI was calculated using slowness, weakness, exhaustion, and flexibility of the sensor-based 20-s repetitive elbow flexion-extension task. RESULTS The UEFI was a significant predictor for gait speed and TUG duration and 5-STS duration (all R ≥ 0.60; all p < 0.001) with the variance (adjusted R2) of 35-37% for the dependent variables. The multivariate regression analysis revealed significant associations between the UEFI and gait speed (β = -0.84; 95% confidence interval [95% CI] = [-1.19, -0.50]; p < 0.001) and TUG duration (β = 16.2; 95% CI = [9.59, 22.8]; p < 0.001) and 5-STS duration (β = 33.3; 95% CI = [23.6, 43.2]; p < 0.001), found after accounting for confounding variables (e.g., age and fear of falling scale). CONCLUSIONS Our findings suggest that the UEFI can be performed with a wrist-worn sensor and has been validated with other established measures of preoperative frailty. The UEFI can be applied in a wide variety of patients, regardless of mobility limitations, in an outpatient setting.
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Affiliation(s)
- Gu Eon Kang
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aanand D Naik
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Margaret M. and Albert B. Alkek Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ravi K Ghanta
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Ben Taub Hospital, Houston, Texas, USA
| | - Todd K Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Division of Vascular Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Sell NM, Qwaider YZ, Goldstone RN, Stafford CE, Cauley CE, Francone TD, Ricciardi R, Bordeianou LG, Berger DL, Kunitake H. Octogenarians present with a less aggressive phenotype of colon adenocarcinoma. Surgery 2020; 168:1138-1143. [PMID: 33041068 DOI: 10.1016/j.surg.2020.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/08/2020] [Accepted: 08/16/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Octogenarians constitute a growing percentage of patients diagnosed with colon malignancies. This study aims to determine if the clinical and pathologic presentation of octogenarians with colon cancer differs from that of patients diagnosed at a younger age. METHODS Data were collected retrospectively for all patients diagnosed with colon cancer who underwent resection at a single institution between January 1, 2004 and December 31, 2017; patients with rectal cancer were excluded. Patients were categorized by age at diagnosis: either 50 to 79 years of age or ≥80 years of age; those <50 years of age were excluded because of the greater risk of a hereditary etiology. The primary outcome was the correlation between patient age and pathologic features of the tumor, including tumor size, lymph node metastases, perineural invasion, and extramural venous invasion. RESULTS Of 1,301 patients, 329 (25%) were ≥80. Female patients predominated the octogenarian cohort (61% vs 39%; P < .001). Octogenarians presented with larger tumors when compared to patients age 50 to 79 (5.2 cm vs 4.5 cm; P < .001). More patients ≥80 had tumors which were >8 cm (17.3% vs 8.9%; P < .001). Tumors in younger patients were more often detected on screening colonoscopy (23.1% vs 7.3%; P < .001). Regardless of tumor size, octogenarians were less likely to have positive lymph nodes than younger patients (P = .02). In addition, octogenarians were less likely to exhibit extramural venous invasion compared to younger patients across all tumor sizes (P < .001). Younger patients had greater median overall survival (6.4 years vs 4.4 years; P < .001), yet 3-year disease-free survival was comparable between age groups (P = .12). CONCLUSION Octogenarians with colon cancer present with larger tumors but appear to have less aggressive disease, as reflected in a lower pathologic stage, less extramural venous invasion, and less lymph node metastases, than younger patients with similar size tumors. Three-year disease-free survival is comparable between octogenarians and patients aged 50 to 79.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA.
| | | | | | | | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Todd D Francone
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - David L Berger
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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Shahrokni A, Vishnevsky BM, Jang B, Sarraf S, Alexander K, Kim SJ, Downey R, Afonso A, Korc-Grodzicki B. Geriatric Assessment, Not ASA Physical Status, Is Associated With 6-Month Postoperative Survival in Patients With Cancer Aged ≥75 Years. J Natl Compr Canc Netw 2020; 17:687-694. [PMID: 31200361 DOI: 10.6004/jnccn.2018.7277] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The American Society of Anesthesiologists physical status (ASA PS) classification system is the most common method of assessing preoperative functional status. Comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool for preoperative assessment of older adults. The goal of this study was to assess the correlation between ASA classification and CGA deficits among oncogeriatric patients and to determine the association of each with 6-month survival. PATIENTS AND METHODS Oncogeriatric patients (aged ≥75 years) who underwent preoperative CGA in an outpatient geriatric clinic at a single tertiary comprehensive cancer center were identified. All patients underwent surgery, with a hospital length of stay (LOS) ≥1 day and at least 6 months of follow-up. ASA classifications were obtained from preoperative anesthesiology notes. Preoperative CGA scores ranged from 0 to 13. Six-month survival was assessed using the Social Security Death Index. RESULTS In total, 81 of the 980 patients (8.3%) included in the study cohort died within 6 months of surgery. Most patients were classified as ASA PS III (85.4%). The mean number of CGA deficits for patients with PS II was 4.03, PS III was 5.15, and PS IV was 6.95 (P<.001). ASA classification was significantly associated with age, preoperative albumin level, hospital LOS, and 30-day intensive care unit (ICU) admissions. On multivariable analysis, 6-month mortality was associated with number of CGA deficits (odds ratio [OR], 1.14 per each unit increase in CGA score; P=.01), 30-day ICU admissions (OR, 2.77; P=.003), hospital LOS (OR, 1.03; P=.02), and preoperative albumin level (OR, 0.36; P=.004). ASA classification was not associated with 6-month mortality. CONCLUSIONS Number of CGA deficits was strongly associated with 6-month mortality; ASA classification was not. Preoperative CGA elicits critical information that can be used to enhance the prediction of postoperative outcomes among older patients with cancer.
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Affiliation(s)
- Armin Shahrokni
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brian Jang
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Saman Sarraf
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Koshy Alexander
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Soo Jung Kim
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Anoushka Afonso
- Department of Anesthesiology & Critical Care, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beatriz Korc-Grodzicki
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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10
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Enhanced recovery program versus conventional care after colorectal surgery in the geriatric population: a systematic review and meta-analysis. Surg Endosc 2020; 35:3166-3174. [DOI: 10.1007/s00464-020-07673-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022]
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Zhao X, Yang Y, Gu H, Zhou W, Zhang Q. New prognostic risk score for predicting in-hospital mortality in geriatric patients undergoing colorectal cancer surgery: U.S. Nationwide Inpatient Sample analysis. J Geriatr Oncol 2020; 11:1250-1254. [PMID: 32376233 DOI: 10.1016/j.jgo.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/21/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To develop a new prognostic risk score index for predicting in-hospital mortality in geriatric patients undergoing colorectal cancer resection. PARTICIPANTS AND METHODS A retrospective study included 111,976 patients with colorectal cancer who were ≥ 65 years of age and underwent resection. The records were extracted from the Nationwide Inpatient Sample (NIS) database between 2005 and 2014. Univariate and multivariate analyses were conducted to determine the associations of in-hospital mortality and demographics, number of comorbidities, clinical and hospital-related characteristics. A prognostic risk score index on in-hospital mortality was established based on the odds ratios of the significant factors. RESULTS 30 points were distributed across the identified predictors of in-hospital mortality. Emergent admission had the greatest impact on mortality (adjusted OR = 3.01) and received the highest ranking with 7 points. The odds were followed by age ≥85 years old and number of comorbidities ≥3 (adjusted OR = 2.58 and 1.99, respectively), which received a rank of 5 points. The other elements of the risk score index were age 75-84 (4 points), male (3 points), tumor located in the colon or with distant metastasis (2 points), and with two comorbidities or socioeconomic status <Q4 (1 point). CONCLUSION This study proposes a novel risk score index for predicting in-hospital mortality in geriatric colorectal cancer patients undergoing resection. This risk score may be helpful for clinicians in decision-making and risk stratification at the pre-surgical phase.
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Affiliation(s)
- Xiaohong Zhao
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
| | - Yunmei Yang
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
| | - Haifeng Gu
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
| | - Wenjing Zhou
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
| | - Qin Zhang
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
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12
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Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery. Anesthesiology 2019; 129:932-941. [PMID: 30028726 DOI: 10.1097/aln.0000000000002357] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
WHAT WE ALREADY KNOW ABOUT THIS TOPIC WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery. METHODS A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor-node-metastasis staging and postoperative metastasis. RESULTS A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor-node-metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor-node-metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings. CONCLUSIONS Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor-node-metastasis stage.
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Emergency Surgery for Obstructive Colon Cancer in Elderly Patients: Results of a Multicentric Cohort of the French National Surgical Association. Dis Colon Rectum 2019; 62:941-951. [PMID: 31283592 DOI: 10.1097/dcr.0000000000001421] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although elderly patients constitute most of the patients undergoing surgery for obstructed colon cancer, available data in the literature are very limited. OBJECTIVE The purpose of this study was to assess the management and outcomes of elderly patients treated for obstructed colon cancer. DESIGN This was a multicenter, retrospective cohort study. SETTINGS Between 2000 and 2015, 2325 patients managed for an obstructed colon cancer in member centers of the French National Surgical Association were identified. Data were collected by each center on a voluntary basis after institutional approval. Bowel obstruction was defined clinically and confirmed by imaging. PATIENTS Three age groups were defined, including patients <75 years, 75 to 84 years, and ≥85 years. MAIN OUTCOME MEASURES Postoperative and oncologic results in elderly patients with an obstructed colon cancer were measured. Relative survival was calculated as the ratio of the overall survival with the survival that would have been expected based on the corresponding general population. INTERVENTIONS A total of 302 patients (13%) underwent colonic stent insertion, and 1992 (87%) underwent surgery as emergency procedure. RESULTS A total of 2294 patients were analyzed (<75 y, n = 1200 (52%); 75-84 y, n = 650 (28%); and ≥85 y, n = 444 (20%)). Elderly patients were more likely to be women (p < 0.0001), to have proximal colon cancer (p < 0.0001), and to have a higher incidence of comorbidities (p < 0.0001). The use of colonic stent or the type of surgery was identical regardless of age. In patients with resected colon cancer, elderly patients had less stage IV disease (p < 0.0001). The absence of tumor resection (p < 0.0001) and definitive stoma rate increased with age (p < 0.0001). Postoperative mortality and morbidity were significantly higher in elderly patients (p < 0.0001), but surgical morbidity was similar across age groups (p = 0.60). Postoperative morbidity was correlated to the 6-month mortality rate in elderly (p < 0.0001). Overall and disease-free survivals were significantly lower in more elderly patients (p < 0.0001) but relative survival was not (p = 0.09). LIMITATIONS It is quite difficult to know how to interpret these data as a whole, given the inherent bias in the study population, lack of ability to stratify by performance status, and long study period duration. CONCLUSIONS Elderly patients have high morbidity with lower survival in the highest age ranges of elderly subgroups. These data should be considered when deciding on an operative approach. See Video Abstract at http://links.lww.com/DCR/A964.
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Jiang HH, Dong XL, Tang X, Li AJ, Chang Y, Li HG, Chen Y, Zhang ZY, Tang EJ, Lin MB. Nomogram for Predicting Risk of Intestinal Complications After Colorectal Cancer Surgery. Med Sci Monit 2019; 25:2104-2111. [PMID: 30897070 PMCID: PMC6439933 DOI: 10.12659/msm.915692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Intestinal complications are a major cause of morbidity after colorectal cancer surgery. This study aimed to develop an effective nomogram for predicting risk of intestinal complications following colorectal cancer surgery. Material/Methods We retrospectively analyzed 1876 patients who underwent colorectal cancer surgery at Yangpu and Zhuji hospitals from January 2013 to October 2018. Intestinal complications were defined as intestinal obstruction, leakage or bleeding, or peritonitis within 30 days after surgery. A logistic regression model was used to identify the risk factors associated with postoperative intestinal complications, and a nomogram for intestinal complications was established. The predictive accuracy of the nomogram was assessed using area under the receiver operating characteristic curve (AUC) and calibration plot. Results A total of 164 patients (8.7%) developed intestinal complications after colorectal cancer surgery; 35 (21.3%) of whom died in the postoperative period. Multivariate logistic analysis showed that male gender, history of abdominal surgery, preoperative intestinal obstruction/perforation, metastatic cancer, and lower level of hemoglobin and prognostic nutrition index were independent risk factors (P<0.05 for all). A nomogram was then constructed, and it displayed good accuracy in predicting postoperative intestinal complications with an AUC of 0.76. The calibration plot also showed an excellent agreement between the predicted and observed probabilities. Conclusions We constructed a nomogram based on clinical variables, which could provide individual prediction of postoperative intestinal complications with good accuracy.
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Affiliation(s)
- Hui-Hong Jiang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Xian-Long Dong
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Xuan Tang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
| | - A-Jian Li
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yi Chang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Hua-Guang Li
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland).,Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Ying Chen
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland).,Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Zhi-Yong Zhang
- Department of General Surgery, Zhuji People's Hospital of Zhejiang Province, Zhuji, Zhejiang, China (mainland)
| | - Er-Jiang Tang
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland).,Center for Clinical Research and Translational Medicine, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Mou-Bin Lin
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China (mainland)
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15
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Boström P, Haapamäki MM, Rutegård J, Matthiessen P, Rutegård M. Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer. BJS Open 2018; 3:106-111. [PMID: 30734021 PMCID: PMC6354192 DOI: 10.1002/bjs5.50106] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/22/2018] [Indexed: 12/19/2022] Open
Abstract
Background Anastomotic leakage following anterior resection for rectal cancer may result in death. The aim of this study was to yield an updated, population‐based estimate of postoperative mortality and evaluate possible interacting factors. Methods This was a retrospective national cohort study of patients who underwent anterior resection between 2007 and 2016. Data were retrieved from a prospectively developed database. Anastomotic leakage constituted exposure, whereas outcome was defined as death within 90 days of surgery. Logistic regression analyses, using directed acyclic graphs to evaluate possible confounders, were performed, including interaction analyses. Results Of 6948 patients, 693 (10·0 per cent) experienced anastomotic leakage and 294 (4·2 per cent) underwent reintervention due to leakage. The mortality rate was 1·5 per cent in patients without leakage and 3·9 per cent in those with leakage. In multivariable analysis, leakage was associated with increased mortality only when a reintervention was performed (odds ratio (OR) 5·57, 95 per cent c.i. 3·29 to 9·44). Leaks not necessitating reintervention did not result in increased mortality (OR 0·70, 0·25 to 1·96). There was evidence of interaction between leakage and age on a multiplicative scale (P = 0·007), leading to a substantial mortality increase in elderly patients with leakage. Conclusion Anastomotic leakage, in particular severe leakage, led to a significant increase in 90‐day mortality, with a more pronounced risk of death in the elderly.
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Affiliation(s)
- P Boström
- Surgery Unit, Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
| | - M M Haapamäki
- Surgery Unit, Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
| | - J Rutegård
- Surgery Unit, Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
| | - P Matthiessen
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences Örebro University Örebro Sweden
| | - M Rutegård
- Surgery Unit, Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
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16
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Gülcü B, Yılmazlar T, Işık Ö, Öztürk E. Colorectal cancer surgery in octogenarians. Turk J Surg 2018; 34:271-275. [PMID: 30248298 DOI: 10.5152/turkjsurg.2018.4018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The incidence of colorectal cancer becomes higher among octogenarians as the life expectancy increases. Whether advanced age is a risk factor for colorectal surgery is a matter of debate. In the present study, the clinical results of octogenarians who underwent colorectal cancer surgery are discussed to find an answer to this question. MATERIAL AND METHODS Data of 63 octogenarians who were operated in a tertiary colorectal surgery department between January 1, 2010 and December 31, 2013 were reviewed retrospectively. Demographic data and preoperative, peroperative, and postoperative parameters were evaluated. RESULTS Overall, 57.2% of the patients were men. The median age was 81 (80-89) years. Cancer was located at the right colon in 17.5%, left colon in 50.8%, and rectum in 31.7%. Eleven patients underwent emergency surgery (17.5%). The most common surgical procedure was low anterior resection in elective (22.2%) and Hartmann's procedure in the emergency setting (9.5%). Stoma creation was more frequent among patients undergoing emergency procedures (42% vs. 6.8%; p=0.0018). Histopathological diagnosis was adenocarcinoma in 90.5% of the patients, and 34.9% of the patients had stage IIIB disease. Surgical morbidity was significantly higher among patients who underwent rectal resection (66% vs. 10.2%; p=0.0124). Medical morbidity was observed in 10 (15.9%) patients. Preoperative blood transfusion was a risk factor for morbidity (83.4% vs. 29.8%; p=0.0170). Length of total hospital stay was 14 (3-39) days. Surgical (p=0.0004) and medical (p=0.0288) morbidity prolonged the length of total hospital stay. The overall mortality rate was 1.6%. CONCLUSION Colorectal surgery may be safely performed in octogenarians with acceptable morbidity and mortality in specialized centers.
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Affiliation(s)
- Barış Gülcü
- Department of General Surgery, Uludag University School of Medicine, Bursa, Turkey
| | - Tuncay Yılmazlar
- Department of General Surgery, Uludag University School of Medicine, Bursa, Turkey
| | - Özgen Işık
- Department of General Surgery, Uludag University School of Medicine, Bursa, Turkey
| | - Ersin Öztürk
- Department of General Surgery, Uludag University School of Medicine, Bursa, Turkey
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17
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Fujie Y, Ota H, Ikenaga M, Hasegawa J, Murata K, Miyake Y, Nishimura J, Hata T, Matsuda C, Mizushima T, Doki Y, Mori M. Evaluation of the feasibility of an "enhanced recovery after surgery" protocol for older patients undergoing colon cancer surgery. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 2:83-89. [PMID: 31559348 PMCID: PMC6752147 DOI: 10.23922/jarc.2017-035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 02/13/2018] [Indexed: 02/04/2023]
Abstract
Objectives: The aim of this study was to evaluate the feasibility of a protocol for enhanced recovery after surgery (ERAS) for colon cancer in older patients. Methods: One hundred and fifty-nine patients enrolled in the ERAS group of our previous clinical study were divided according to age into an older group (n = 31; ≥80 years old) and a younger group (n = 128; <80 years old). We compared the two groups for clinical outcomes, including surgical complications, re-admission rates, and the time to discharge, based on criteria for hospital discharge. Compliance with each ERAS element was compared between groups. Results: Concomitant diseases were present in all older patients (100%), but only in 57.8% of the younger group (P < 0.0001). The preoperative risk grade according to the American Society of Anesthesiologists classification was significantly higher in the older group than in the younger group. The postoperative surgical complications and re-admission rates were not significantly different between groups. Discharge criteria were met three days after the operation. The median length of hospital stay was slightly longer in the older group (9 days, range 5-15) than in the younger group (8 days, range 4-41; P = 0.061). Compliance above 80% was observed for 13 ERAS items in the older group and 14 ERAS items in the younger group; thus, compliance with the ERAS protocol was equally feasible in both groups. Conclusions: For older patients undergoing colon cancer surgery, an ERAS protocol might be feasible with a high implementation rate of the elements in the protocol.
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Affiliation(s)
- Yujiro Fujie
- Department of Surgery, NTT WEST Osaka Hospital, Osaka, Japan
| | - Hirofumi Ota
- Department of Digestive Surgery, Ikeda City Hospital, Ikeda, Japan.,Department of Surgery, Osaka Saiseikai Senri Hospital, Suita, Japan
| | - Masakazu Ikenaga
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan.,Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Kohei Murata
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yasuhiro Miyake
- Department of Surgery, Nishinomiya Municipal Hospital, Nishinomiya, Japan.,Department of Surgery, Mino City Hospital, Mino, Japan
| | - Junichi Nishimura
- Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taishi Hata
- Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chu Matsuda
- Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunekazu Mizushima
- Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Mori
- Department of Digestive Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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18
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Kochi M, Hinoi T, Niitsu H, Ohdan H, Konishi F, Kinugasa Y, Kobatake T, Ito M, Inomata M, Yatsuoka T, Ueki T, Tashiro J, Yamaguchi S, Watanabe M. Risk factors for postoperative pneumonia in elderly patients with colorectal cancer: a sub-analysis of a large, multicenter, case-control study in Japan. Surg Today 2018; 48:756-764. [PMID: 29594413 DOI: 10.1007/s00595-018-1653-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/26/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Postoperative pneumonia affects the length of stay and mortality after surgery in elderly patients with colorectal cancer (CRC). We aimed to determine the risk factors of postoperative pneumonia in elderly patients with CRC, and to evaluate the impact of laparoscopic surgery on elderly patients with CRC. METHODS We retrospectively investigated 1473 patients ≥ 80 years of age who underwent surgery for stage 0-III CRC between 2003 and 2007. Using a multivariate analysis, we determined the risk factors for pneumonia occurrence from each baseline characteristic. RESULTS Among all included patients, 26 (1.8%) experienced postoperative pneumonia, and restrictive respiratory impairment, obstructive respiratory impairment, history of cerebrovascular events, and open surgery were determined as risk factors (odds ratio [95% confidence interval], 2.78 [1.22-6.20], 2.71 [1.22-6.30], 3.60 [1.37-8.55], and 3.57 [1.22-15.2], respectively). Furthermore, postoperative pneumonia was more frequently accompanied by increasing cumulative numbers of these risk factors (area under the receiver operating characteristic curve = 0.763). CONCLUSIONS Laparoscopic surgery may be safely performed in elderly CRC patients, even those with respiratory impairment and a history of cerebrovascular events.
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Affiliation(s)
- Masatoshi Kochi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Takao Hinoi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan. .,Department of Surgery, Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chu-goku Cancer Center, 3-1, Aoyama-cho, Kure-shi, Hiroshima, 737-0023, Japan.
| | - Hiroaki Niitsu
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Fumio Konishi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Ohmiya-ku, Saitama, 330-8503, Japan.,Department of Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima, Tokyo, 179-0072, Japan
| | - Yusuke Kinugasa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.,Department of Gastroenterological Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Takaya Kobatake
- Department of Surgery, Division of Gastroenterological Surgery, National Hospital Organization Shikoku Cancer Center, 160 Koh, Umemotomachi, Matsuyama, Ehime, 791-0280, Japan
| | - Masaaki Ito
- Division of Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hazama-cho, Yufu, Oita, 879-5593, Japan
| | - Toshimasa Yatsuoka
- Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro, Inamachi, Kita-Adachi-gun, Saitama, 362-0806, Japan.,Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan
| | - Takashi Ueki
- Department of Surgery and Oncology, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Department of Gastroenterological Surgery, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan
| | - Jo Tashiro
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
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Hatch JL, Bauschard MJ, Nguyen SA, Lambert PR, Meyer TA, McRackan TR. National Trends in Vestibular Schwannoma Surgery: Influence of Patient Characteristics on Outcomes. Otolaryngol Head Neck Surg 2018; 159:102-109. [PMID: 29584554 DOI: 10.1177/0194599818765717] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective To characterize current vestibular schwannoma (VS) surgery outcomes with a nationwide database and identify factors associated with increased complications and prolonged hospital course. Study Design Retrospective review utilizing the University HealthSystem Consortium national inpatient database. Setting US academic health centers. Subjects and Methods Data from patients undergoing VS surgery were analyzed over a 3-year time span (October 2012 to September 2015). Surgical outcomes, such as length of stay (LOS), complications, and mortality, were analyzed on the basis of race, sex, age, and comorbidities during the 30-day postoperative period. Results A total of 3697 VS surgical cases were identified. The overall mortality rate was 0.38%, and the overall complication rate was 5.3%. Advanced age significantly affected intensive care unit LOS, mortality, and complications ( P = .04). Comorbidities, including hypertension, obesity, and depression, also significantly increased complication rates ( P = .02). Sixty-eight patients (1.8%) had a history of irradiation, and they had a significantly increased LOS ( P = .03). Conclusion Modern VS surgery has a low mortality rate and a relatively low rate of complications. Several factors contribute to high complication rates, including age and comorbidities. These data will help providers in counseling patients on which treatment course might be best suited for them.
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Affiliation(s)
- Jonathan L Hatch
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael J Bauschard
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore R McRackan
- 1 Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Gagnière J, Veziant J, Pereira B, Pezet D, Le Roy B, Slim K. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for the Elderly: Is It Reasonable? A Meta-Analysis. Ann Surg Oncol 2017; 25:709-719. [PMID: 29282602 DOI: 10.1245/s10434-017-6313-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Whether cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is safe and worthwhile for elderly patients remains unclear. This meta-analysis of outcomes after CRS plus HIPEC for the elderly aimed to generate a higher level of evidence and precise indications for these patients. METHODS A systematic literature search for studies reporting postoperative outcomes after CRS plus HIPEC for elderly patients was performed in the MEDLINE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Web of Knowledge Conference Proceedings Citation Index-Science, and Google Scholar databases. The included studies evaluated the overall 30-day postoperative morbidity, 90-day postoperative mortality, grade 3 or higher postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay. RESULTS The inclusion criteria were met by 13 retrospective studies involving 2544 patients. Considering only comparative studies, the 90-day postoperative mortality was significantly increased for elderly patients [odds ratio (OR), 0.49; 95% confidence interval (CI), 0.27-0.88; I 2 = 79%]. The 30-day grade 3 or higher postoperative morbidity was increased in the patients 70 years of age or older (14.5%; 95% CI 8.1-24.4 vs. 32.3%; 95% CI 22.4-44.0%; p = 0.004; I 2 = 85%). The overall 30-day postoperative morbidity, rates of anastomotic leaks, reoperation and readmission, and length of hospital stay were not affected by age. CONCLUSIONS Treatment of the elderly with CRS plus HIPEC was associated with increased severe postoperative morbidity and mortality. However, these conclusions should be weighted given the existence of major biases in the included studies. Age alone probably would not be a formal contraindication, but frailty should be taken into account. Further prospective studies are needed.
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Affiliation(s)
- Johan Gagnière
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. .,U1071 INSERM, Université Clermont-Auvergne, Clermont-Ferrand, France.
| | - Julie Veziant
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,U1071 INSERM, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics, Délégation à la Recherche Clinique et à l'Innovation, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Pezet
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.,U1071 INSERM, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Bertrand Le Roy
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Karem Slim
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Santos DA, Alseidi A, Shannon VR, Messick C, Song G, Ledet CR, Lee H, Ngo-Huang A, Francis GJ, Asher A. Management of surgical challenges in actively treated cancer patients. Curr Probl Surg 2017; 54:612-654. [DOI: 10.1067/j.cpsurg.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Enhanced Recovery Program in High-Risk Patients Undergoing Colorectal Surgery: Results from the PeriOperative Italian Society Registry. World J Surg 2017; 41:860-867. [PMID: 27766398 DOI: 10.1007/s00268-016-3766-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) pathways represent the optimal approach for patients undergoing colorectal surgery. Elderly or low physical status patients have been often excluded from ERAS pathways because considered at high risk. The aim of this study is to assess the adherence to ERAS protocol and its impact on short-term postoperative outcome in patients with different surgical risk undergoing elective colorectal resection. METHODS Prospectively collected data entered in an electronic Italian registry specifically designed for ERAS were reviewed. Patients were divided into four groups according to age (70-year-old cutoff) and preoperative physical status as measured by the ASA grade (I-II vs. III-IV). Adherence to 18 ERAS elements and postoperative outcomes were compared between groups. Regression analysis was used to identify independent factors associated with improved outcomes. RESULTS Eleven Italian hospitals reported data on 706 patients undergoing elective colorectal surgery within an ERAS protocol. Patients with low physical status had reduced adherence to preoperative carbohydrate loading, epidural analgesia, PONV prophylaxis, and early urinary catheter removal. No difference was found between groups for adherence to other perioperative elements. Major complications occurred in 37 (5.2 %) patients without significant differences among groups (p = 0.384). Median (IQR) time to readiness for discharge (TRD) was 4 (3-6) days, length of hospital stay (LOS) was 6 (4-7) days, and both were significantly shorter by only 1 day in the groups of younger patients (p < 0.001). At multivariate analysis, laparoscopy increased adherence to ERAS items and reduced TRD, LOS, and morbidity. A high ASA grade was significantly associated with lower adherence, whereas older age significantly prolonged TRD and LOS. CONCLUSION ERAS pathway can be safely applied in elderly and low physical status patients yielding slight differences in postoperative morbidity and time to recover. Laparoscopy was independently associated with increased adherence to ERAS protocol and improved short-term postoperative outcome.
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Gebauer B, Meyer F, Ptok H, Steinert R, Otto R, Lippert H, Gastinger I. Impact of Body Mass Index on Early Postoperative and Long-Term Outcome after Rectal Cancer Surgery. Visc Med 2017; 33:373-382. [PMID: 29177167 DOI: 10.1159/000479852] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The aim of this study was to investigate the impact of obesity and underweight onto early postoperative and long-term oncological outcome after surgery for rectal cancer. Methods Data from 2008 until 2011 was gathered by a German prospective multicenter observational study. 62 items were reported by the physicians in charge, and a consecutive follow-up was performed if the patient had signed a consent form. Patients were subclassified into: underweight, normal weight, overweight, and obese - using the definitions of the World Health Organization. Results In total, 9,920 patients were included, of whom 2.1% were underweight and 19.4% obese. The mean age was 68 years (range 21-99 years). Postoperative morbidity (mean 38.0%) was significantly increased in underweight and obese patients (p < 0.001). In-hospital mortality was 3.1% on average with no significant differences among patient groups (p = 0.176). The 5-year overall survival ranged between 36.9 and 61.3% and was worse in underweight and prolonged in overweight and obese patients compared to those with normal weight (p < 0.001 each). While the 5-year disease-free survival was increased in overweight and obese patients (p < 0.05 each), the 5-year local recurrence rate showed no correlation (p > 0.05 each). Multivariate analysis revealed that advanced age, higher ASA scoring, postoperative morbidity, and advanced tumor growth worsened the long-term survival independently. Conclusions Underweight patients had a worse early and long-term outcome after rectal cancer surgery. Overweight and obesity were associated with a significantly better long-term survival.
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Affiliation(s)
- Björn Gebauer
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany.,Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Frank Meyer
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany.,Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Henry Ptok
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany.,Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany
| | - Ralf Steinert
- Department of General and Abdominal Surgery, St Joseph Hospital, Salzkotten, Germany
| | - Ronny Otto
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
| | - Hans Lippert
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
| | - Ingo Gastinger
- Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
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Abstract
This study aimed to assess perioperative morbidity and mortality in elderly patients following colorectal cancer resection and to investigate risk factors for postoperative complications. This study reviewed 697 consecutive patients who underwent elective colorectal cancer resection between 2005 and 2013 at our institution. Patients were divided into 3 groups according to their age: ≤74 (n = 420), 75 to 89 (n = 261), and ≥90 years (n = 16). Clinical findings, morbidity, and mortality were compared among these groups. Univariate and multivariate logistic regression analyses were performed with clinically relevant variables for the complications that increased with aging. Postoperative delirium and pneumonia showed significant increases with aging. There were no significant differences in mortality and morbidity among the 3 groups, except for the 2 aforementioned diseases. Multiple logistic regression analysis showed that dementia and laparoscopic surgery were independent determinants of postoperative delirium and that age and American Society of Anesthesiologists (ASA) score were independent risk factors for postoperative pneumonia. Dementia, high ASA score, and age were the risk factors for higher postoperative morbidity in elderly patients. Our results demonstrated the effectiveness of laparoscopic surgery for the prevention of postoperative delirium after colorectal resection.
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Pirrera B, Lucchi A, Gabbianelli C, Alagna V, Martorelli G, Berti P, Panzini I, Fabbri E, Garulli G. E.R.A.S. pathway in colorectal surgery in elderly: Our experience: A retrospective cohort study. Int J Surg 2017; 43:101-106. [PMID: 28483663 DOI: 10.1016/j.ijsu.2017.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 02/08/2023]
Abstract
AIM Numerous geriatric patients develop colorectal disease. Elderly patients are often considered high-risk surgical candidates. Enhanced recovery after surgery (E.R.A.S.) has been proven to be beneficial for patients. The aim of the study was to evaluate the results of an ERAS protocol in older patients that underwent colorectal surgery compared to younger patients. METHOD In the period between January 2010 to December 2015 a total of 589 patients underwent elective colorectal surgical interventions treated within the E.R.A.S pathway: 211 patients younger than 65 years, 175 patients aged from 66 years to 75 years, and 203 patients older than 75 years. End point of interest were postoperative complications, 90-day mortality, length of hospital stay and readmission within 30 days. RESULTS Significant differences between the three groups were observed for comorbidities (p:0.001); in particular older patients had significantly more diabetes, renal, cardiac, and respiratory diseases, ASA (p < 0.001), presence of malignancy (p < 0.001). However there were not differences between the groups in surgical procedures (p = 0.095), operative time (p = 0.823), anastomotic leakage (p = 0.960), hospital stay (p = 0.081), readmission rate (p = 0.904), 90-days mortality (p = 0.183) and morbidity (p = 0.973) in accordance with Clavien-Dindo classification. Multivariate logistic regression analysis showed that advanced age in E.R.A.S. pathway is not a predictive factor of morbidity, readmission within 30 days and 90-day mortality. CONCLUSION There was no significant difference in morbidity, 90-day mortality, length of stay or readmission rate in patients aged over 75 years compared with younger patients. Old age does not represent a contraindication to the implementation of the E.R.A.S protocol in patients that underwent colorectal surgery. WHAT DOES THIS PAPER ADD TO THE EXISTING LITERATURE?: In the literature there are not many studies that address the impact of older age in the treatment of colorectal disease in an ERAS program. The aging of the population raises new questions in the management of the colorectal surgery in the elderly. ERAS pathway has been proven to be beneficial for patients, which results in a reduction of postoperative morbidity. Compared to what is reported in the literature this study confirms that ERAS program in colorectal surgery can be applied in older patients with no significant difference in morbidity, 90-day mortality, length of stay or readmission rate compared with younger.
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Affiliation(s)
- Basilio Pirrera
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy.
| | - Andrea Lucchi
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy
| | - Carlo Gabbianelli
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy
| | - Vincenzo Alagna
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy
| | - Giacomo Martorelli
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy
| | - Pierluigi Berti
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy
| | - Ilaria Panzini
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy
| | - Elisabetta Fabbri
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy
| | - Gianluca Garulli
- General, Thoracic and Minimally Invasive Surgery, Ceccarini Hospital, Riccione, Italy
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Safety of laparoscopic surgery for colorectal cancer in patients over 80 years old: a propensity score matching study. Surg Today 2017; 47:951-958. [PMID: 28130643 DOI: 10.1007/s00595-017-1470-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/28/2016] [Indexed: 02/08/2023]
Abstract
PURPOSES To establish the safety of laparoscopic-assisted colorectal resection for colorectal cancer in elderly patients aged ≥80 years. METHODS Data were obtained from a chart review of patients who underwent colorectal cancer resection between 2009 and 2014 in Kochi Medical School. The effect of patient age on the extent of lymph node dissection and operative safety was assessed by comparing the short-term results of elderly patients with those of younger patients after propensity score matching. RESULTS Of a total of 506 patients with colorectal cancer, 398 underwent laparoscopic surgery and 23% of these patients were aged ≥80 years old. The elderly patients tended to have poorer general condition and larger tumors, although no significant differences were found in tumor invasion, lymph node metastasis, or synchronous distant metastasis between the groups. After adjustment for preoperative factors, we noted that the elderly patients tended to undergo less aggressive surgical resection (P = 0.01). Further analysis after including surgical factors for propensity score matching revealed a similar rate of complications in the two groups (24 vs. 25%, respectively; P = 0.85), and similar postoperative death rates and length of postoperative hospital stay. CONCLUSION The findings of the present study demonstrate that laparoscopic surgery for colorectal cancer should not be avoided based on simply the age of the patient.
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Pirrera B, Vaccari S, Cuicchi D, Lecce F, De Raffele E, Via BD, Di Laudo M, Tonini V, Cervellera M, Cola B. Impact of octogenarians on surgical outcome in colorectal cancer. Int J Surg 2016; 35:28-33. [PMID: 27616059 DOI: 10.1016/j.ijsu.2016.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/11/2016] [Accepted: 09/06/2016] [Indexed: 02/08/2023]
Abstract
AIM Colorectal cancer's (CRC) incidence occupies the second place among malignant tumours in men and the third place in women. The aging of the population raises new questions on the management of CRC in octogenarian patients. The objective of this study was to assess the influence of age (≥80) on treatment and surgical outcome of colorectal cancer. METHOD In the period between October 1995 and April 2014, a total of 1397 patients underwent emergency and elective surgical interventions for CRC; the first group (Group-Older - GO) was composed of 291 patients 80 years or older (20.9%, of which 46.4% were male). The second group (Group-Younger - GY) included 1106 patients younger than 80 years (79,1%, 57.7% males). RESULTS Significant differences between the two groups were observed regarding sex (p = 0.001), number of comorbidities (p = 0.001), ASA classification (p < 0.001), emergency presentation (p < 0.001), site of tumor (p = 0.010), need of intraoperative blood transfusions (p < 0.001), 30-days mortality (p < 0.001), 90-days mortality (p < 0.001) and morbidity in accordance with Clavien-Dindo classification (p < 0.001). When combining both elective and emergency procedures, multivariate logistic regression analysis showed that advanced age (≥80 years old) was an independent predictor factor of 30-days mortality (p = 0.023, OR = 2.23) and morbidity (p = 0.088, OR = 1.31), while it was not predictive of 90-days mortality. When considering only elective colorectal surgery, octogenarian age was not found to be a predictive factor of 30-day and 90-day mortality, but predictive of postoperative morbidity. CONCLUSION Old age (≥80) does not represent a contraindication to CRC elective surgical treatment, in emergency procedures it is associated with an increased risk of postoperative morbidity and mortality.
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Affiliation(s)
- Basilio Pirrera
- Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
| | - Samuele Vaccari
- Unit of Emergency Surgery, Emergency Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Dajana Cuicchi
- Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Ferdinando Lecce
- Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Emilio De Raffele
- Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Barbara Dalla Via
- Unit of Emergency Surgery, Emergency Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Marco Di Laudo
- Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Valeria Tonini
- Unit of Emergency Surgery, Emergency Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Maurizio Cervellera
- Unit of Emergency Surgery, Emergency Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
| | - Bruno Cola
- Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy
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Shalaby M, Di Lorenzo N, Franceschilli L, Perrone F, Angelucci GP, Quareisma S, Gaspari AL, Sileri P. Outcome of Colorectal Surgery in Elderly Populations. Ann Coloproctol 2016; 32:139-43. [PMID: 27626024 PMCID: PMC5019966 DOI: 10.3393/ac.2016.32.4.139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/23/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose The aim of this study is to investigate the impact of age on short-term outcomes after colorectal surgery in terms of the 30-day postoperative morbidity and mortality rates. Methods The subjects for the study were patients who had undergone colorectal surgery. Patients were divided into 2 groups according to age; groups A and B patients were ≥80 and <80 years old of age, respectively. Both groups were manually matched for body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index and procedure performed. Results A total of 200 patients, 91 men (45.5%) and 109 women (54.5%), were included in this retrospective study. These patients were equally divided into 2 groups. The mean ages were 85 years in group A (range, 80 to 104 years) and 55.3 years in group B (range, 13 to 79 years). The overall 30-day postoperative mortality rate was 1% of total 200 patients; both of these 2 patients were in group A. However, this observation had no statistical significance. No intraoperative complications were encountered in either group. The overall 30-day postoperative morbidity rate was 27% (54 of 200) for both groups. The 30-day postoperative morbidity rates in groups A and B were 28% (28 of 100) and 26% (26 of 100), respectively. However, these differences between the groups had no statistical significance importance. Conclusion Age alone should not be considered to be more of a contraindication or a worse predictor than other factors for the outcome after colorectal surgery on elderly patients.
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Affiliation(s)
- Mostafa Shalaby
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Nicola Di Lorenzo
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Luana Franceschilli
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Federico Perrone
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Giulio P Angelucci
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Quareisma
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Achille L Gaspari
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Pierpaolo Sileri
- Department of General Surgery, UOC B, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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Pérez Domínguez L, Cáceres Alvarado N, Toscano Novella Á, Casal Núñez JE. Results of colon cancer surgery in patients over 75 years old. ANZ J Surg 2016; 88:E11-E15. [DOI: 10.1111/ans.13666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/02/2016] [Accepted: 05/22/2016] [Indexed: 01/24/2023]
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Differences between colon and rectal cancer in complications, short-term survival and recurrences. Int J Colorectal Dis 2016; 31:1683-91. [PMID: 27497831 PMCID: PMC5031780 DOI: 10.1007/s00384-016-2633-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Many apparent differences exist in aetiology, genetics, anatomy and treatment response between colon cancer (CC) and rectal cancer (RC). This study examines the differences in patient characteristics, prevalence of complications and their effect on short-term survival, long-term survival and the rate of recurrence between RC and CC. METHODS For all stage II-III CC and RC patients who underwent resection with curative intent (2006-2008) in five hospitals in the Netherlands, occurrence of complications, crude survival, relative survival and recurrence rates were compared. RESULTS A total of 767 CC and 272 RC patients underwent resection. Significant differences were found for age, gender, emergency surgery, T-stage and grade. CC patients experienced fewer complications compared to RC (p = 0.019), but CC patients had worse short-term mortality rates (1.5 versus 6.7 % for 30-day mortality, p = 0.001 and 5.2 versus 9.5 % for 90-day mortality, p = 0.032). The adjusted HR (overall survival) for CC patients with complications was 1.57 (1.23-2.01; p < 0.001) as compared to patients without complications; for RC, the HR was 1.79 (1.12-2.87; p = 0.015). Relative survival analyses showed high excess mortality in the first months after surgery and a sustained, prolonged negative effect on both CC and RC. Complications were associated with a higher recurrence rate for both CC and RC; adjusted analyses showed a trend towards a significant association. CONCLUSION Large differences exist in patient characteristics and clinical outcomes between CC and RC. CC patients have a significantly higher short-term mortality compared to RC patients due to a more severe effect of complications.
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Niitsu H, Hinoi T, Kawaguchi Y, Ohdan H, Hasegawa H, Suzuka I, Fukunaga Y, Yamaguchi T, Endo S, Tagami S, Idani H, Ichihara T, Watanabe K, Watanabe M. Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case-control study in Japan. J Gastroenterol 2016; 51:43-54. [PMID: 25940149 DOI: 10.1007/s00535-015-1083-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/11/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status. METHODS In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case-control study entitled "Retrospective study of laparoscopic colorectal surgery for elderly patients" that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared. RESULTS Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P < 0.001), and less blood loss occurred with laparoscopic surgery (median open surgery, 109 g; median laparoscopic surgery, 30 g; P < 0.001). An operation duration of 180 min or more (odds ratio, 1.97; 95 % confidence interval, 1.17-3.37; P = 0.011) and selection of laparoscopic surgery (odds ratio, 0.41; 95 % confidence interval, 0.22-0.75; P = 0.003) were statistically significant in the multivariate analysis for postoperative morbidity. Moreover, laparoscopic surgery did not result in an inferior overall survival rate compared with open surgery (log-rank test P = 0.289, 0.278, 0.346, 0.199, for all-stage, stage 0-I, stage II, and stage III disease, respectively). CONCLUSIONS Laparoscopic surgery in elderly colorectal cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival.
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Affiliation(s)
- Hiroaki Niitsu
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Takao Hinoi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Yasuo Kawaguchi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | | | - Ichio Suzuka
- Department of Gastrointestinal and General Surgery, Kagawa Prefectural Central Hospital, Kagawa, Japan
- Department of Surgery, Ako Central Hospital, Hyogo, Japan
| | - Yosuke Fukunaga
- Department of Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Takashi Yamaguchi
- Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shungo Endo
- Digestive Disease Center, Northern Yokohama Hospital, Showa University, Yokohama, Japan
- Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Soichi Tagami
- Department of Surgery, Nagano Municipal Hospital, Nagano, Japan
- Department of Surgery, Shohnan Tobu General Hospital, Kanagawa, Japan
| | - Hitoshi Idani
- Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takao Ichihara
- Department of Surgery, Nishinomiya Municipal Central Hospital, Hyogo, Japan
- Digestive Disease Center, Amagasaki Chuo Hospital, Hyogo, Japan
| | - Kazuteru Watanabe
- Department of Gastroenterological Surgery, Yokohama City University Medical Center, Kanagawa, Japan
- NTT Medical Center Tokyo, Tokyo, Japan
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Kang T, Kim HO, Kim H, Chun HK, Han WK, Jung KU. Age Over 80 is a Possible Risk Factor for Postoperative Morbidity After a Laparoscopic Resection of Colorectal Cancer. Ann Coloproctol 2015; 31:228-34. [PMID: 26817018 PMCID: PMC4724704 DOI: 10.3393/ac.2015.31.6.228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/05/2015] [Indexed: 01/01/2023] Open
Abstract
Purpose With extended life expectancy, the mean age of patients at the time of diagnosis of colorectal cancer and its treatment, including radical resection, is increasing gradually. We aimed to evaluate the impact of age on postoperative clinical outcomes after a laparoscopic resection of colorectal cancers. Methods This is a retrospective review of prospectively collected data. Patients with primary colorectal malignancies or premalignant lesions who underwent laparoscopic colectomies between January 2009 and April 2013 were identified. Patients were divided into 6 groups by age using 70, 75, and 80 years as cutoffs: younger than 70, 70 or older, younger than 75, 75 or older, younger than 80, and 80 or older. Demographics, pathological parameters, and postoperative clinical outcomes, including postoperative morbidity, were compared between the younger and the older age groups. Results All 578 patients underwent a laparoscopic colorectal resection. The overall postoperative complication rate was 21.1% (n = 122). There were 4 cases of operative mortality (0.7%). Postoperative complication rates were consistently higher in the older groups at all three cutoffs; however, only the comparison with a cutoff at 80 years showed a statistically significant difference between the younger and the older groups. Conclusion Age over 80 is a possible risk factor for postoperative morbidity after a laparoscopic resection of colorectal cancer.
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Affiliation(s)
- Taekhyun Kang
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Korea
| | - Hungdai Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Korea
| | - Won Kon Han
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Korea
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University of School of Medicine, Seoul, Korea
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Cooper Z, Mitchell SL, Gorges RJ, Rosenthal RA, Lipsitz SR, Kelley AS. Predictors of Mortality Up to 1 Year After Emergency Major Abdominal Surgery in Older Adults. J Am Geriatr Soc 2015; 63:2572-2579. [PMID: 26661929 DOI: 10.1111/jgs.13785] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify factors associated with mortality in older adults 30, 180, and 365 days after emergency major abdominal surgery. DESIGN A retrospective study linked to Medicare claims from 2000 to 2010. SETTING Health and Retirement Study (HRS). PARTICIPANTS Medicare beneficiaries aged 65.5 enrolled in the HRS from 2000 to 2010 with at least one urgent or emergency major abdominal surgery and a core interview from the HRS within 3 years before surgery. MEASUREMENTS Survival analysis was used to describe all-cause mortality 30, 180, and 365 days after surgery. Complementary log-log regression was used to identify participant characteristics and postoperative events associated with poorer survival. RESULTS Four hundred individuals had one of the urgent or emergency surgeries of interest, 24% of whom were aged 85 and older, 50% had coronary artery disease, 48% had cancer, 33% had congestive heart failure, and 37% experienced a postoperative complication. Postoperative mortality was 20% at 30 days, 31% at 180 days, and 34% at 365 days. Of those aged 85 and older, 50% were dead 1 year after surgery. After multivariate adjustment including postoperative complications, dementia (hazard ratio (HR) = 2.02, 95% confidence interval (CI) = 1.24-3.31), hospitalization within 6 months before surgery (HR = 1.63, 95% CI = 1.12-2.28), and complications (HR = 3.45, 95% CI = 2.32-5.13) were independently associated with worse 1-year survival. CONCLUSION Overall mortality is high in many older adults up to 1 year after undergoing emergency major abdominal surgery. The occurrence of a complication is the clinical factor most strongly associated with worse survival.
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Affiliation(s)
- Zara Cooper
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan L Mitchell
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Rebecca J Gorges
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronnie A Rosenthal
- Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amy S Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,James J. Peters Veterans Affairs Medical Center, Bronx, New York
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Cooper Z, Scott JW, Rosenthal RA, Mitchell SL. Emergency Major Abdominal Surgical Procedures in Older Adults: A Systematic Review of Mortality and Functional Outcomes. J Am Geriatr Soc 2015; 63:2563-2571. [PMID: 26592523 PMCID: PMC4827160 DOI: 10.1111/jgs.13818] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To systematically review the current literature on mortality and functional outcomes after emergency major abdominal surgery in older adults. DESIGN Systematic literature search and standardized data collection of primary research publications from January 1994 through December 2013 on mortality or functional outcome in adults aged 65 and older after emergency major abdominal surgery using PubMed, EMBASE, Web of Science, Cochrane, and CINAHL. Bibliographies of relevant reports were also hand-searched to identify all potentially eligible studies. SETTING Systematic review of retrospective and cohort studies using Preferred Reporting Items for Systematic reviews and Meta-Analyses, Meta-analysis Of Observational Studies in Epidemiology, Strengthening the Reporting of Observational Studies in Epidemiology, and A Measurement Tool to Assess Systematic Reviews guidelines. PARTICIPANTS Older adults. MEASUREMENTS Articles were assessed using a standardized quality scoring system based on study design, measurement of exposures, measurement of outcomes, and control for confounding. RESULTS Of 1,459 articles screened, 93 underwent full-text review, and 20 were systematically reviewed. In-hospital and 30-day mortality of all older adults exceeded 15% in 14 of 16 studies, where reported. Older adults undergoing emergency major abdominal surgery consistently had higher mortality across study settings and procedure types than younger individuals undergoing emergency procedures and older adults undergoing elective procedures. In studies that stratified older adults, odds of death increased with age. None of these studies examined postoperative functional status, which precluded including functional outcomes in this review. Differences in exposures, outcomes, and data presented in the studies did not allow for quantification of association using metaanalysis. CONCLUSION Age independently predicts mortality after emergency major abdominal surgery. Data on changes in functional status of older adults who undergo these procedures are lacking.
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Affiliation(s)
- Zara Cooper
- Department of Surgery, Brigham and Women’s Hospital
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - John W. Scott
- Department of Surgery, Brigham and Women’s Hospital
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ronnie A. Rosenthal
- Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut
| | - Susan L. Mitchell
- Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Dinnewitzer A, Nawara C, Augschöll C, Neureiter D, Hitzl W, Öfner D, Jäger T. The impact of advanced age on short- and long-term results after surgery for colorectal cancer. Eur Surg 2015. [DOI: 10.1007/s10353-015-0355-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Implantation of a new enteral stent in obstructive colorectal cancer using interventional radiology in patients over 70 years of age. Wideochir Inne Tech Maloinwazyjne 2015; 10:155-60. [PMID: 26240614 PMCID: PMC4520849 DOI: 10.5114/wiitm.2015.52266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/04/2015] [Accepted: 05/12/2015] [Indexed: 12/05/2022] Open
Abstract
Introduction Colorectal cancer is the second leading cause of death due to cancer in Poland. The traditional approach to treat patients included a surgical procedure. Irrespective of the surgical method being used, surgical treatment of malignant colorectal obstruction is associated with prolonged hospitalisation, and the postoperative mortality rate is approximately 5–11%. Due to these problems, more interest has been shown in less invasive methods. Prosthesis implantation is a leading endoscopic method used currently in palliative or preoperative treatment. Aim To compare the results of implantation of traditional stents with the results of implantation of an own stent using minimally invasive methods. Material and methods Left-sided colon obstruction due to cancer was an indication for transplantation. All patients were aged over 70 years and had serious concomitant diseases. The control group included 50 patients with colorectal cancer who received traditional stents in the period 2009–2011. Our stent covers only the internal length of a tumour. It is not equipped with anti-migration flares. To minimize the risk of migration it has a system of hooks that are responsible for permanent anchorage of the stent within the tumour mass. Results Implantation technical and clinical success defined as effective decompression of intestinal obstruction was 100% in both groups. There were 2 cases of stent migration in the control group. Conclusions It is possible to achieve a secure surgical anastomosis after intestinal decompression. Stent implantation is fast and safe thanks to the positioning system that was used. The use of labelled hooks is a secure anti-migration solution.
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A qualitative study assessing the barriers to implementation of enhanced recovery after surgery. World J Surg 2015; 38:1374-80. [PMID: 24385194 DOI: 10.1007/s00268-013-2441-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have quantitatively assessed Enhanced Recovery After Surgery (ERAS) guideline implementation and compliance, and identified the existence of compliance issues with the programs. This is the first study to qualitatively assess the reasons behind compliance issues in ERAS programs. The aim of this study was to elicit barriers to implementation and functioning of the ERAS program at Royal Prince Alfred Hospital. METHODS A series of interviews were carried out with key stakeholders in order to explore barriers preventing effective functioning of the program 1 year after implementation. Interview transcripts were analysed. Data analysis involved a grounded theory methodology. RESULTS Analysis of the data identified four key themed areas of practice that presented barriers: patient-related factors, staff-related factors, practice-related issues, and resources. These overarching themes were generated from subcategories that were linked to generate theory. CONCLUSIONS For the ERAS program to be implemented successfully with high levels of element compliance, the four key areas need to be addressed. As barriers to ongoing effective care become apparent, these should be managed in order to optimize the synergistic effects of this multimodal program of patient care.
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Ming-Gao G, Jian-Zhong D, Yu W, You-Ben F, Xin-Yu H. Colorectal cancer treatment in octogenarians: elective or emergency surgery? World J Surg Oncol 2014; 12:386. [PMID: 25519055 PMCID: PMC4302045 DOI: 10.1186/1477-7819-12-386] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 12/03/2014] [Indexed: 01/25/2023] Open
Abstract
Background The purpose of this research was to assess the characteristics of octogenarian patients with colorectal cancer and compare specific outcomes due to different types of surgical procedures used to treat the disease. Methods A total of 346 octogenarian patients undergoing surgery for colorectal cancer between April 2000 and April 2010 were retrospectively assessed according to elective (n = 261) or emergent (n = 85) admission group. The two groups were compared for clinical variables, surgical procedures, morbidity and mortality, ICU admission, length of hospital stay and overall survival. Results The two groups had similar comorbidities. The emergent group had a more advanced Dukes’ stage, higher American Society of Anesthesiologists grading, lower anastomosis rate (40.2 vs 80.1%), higher stoma rate (30.6 vs 9.6%), more complications (71.8 vs 43.3%), nine days longer length of hospital stay and higher (82.4% vs 36.4%) ICU admission rate. Overall mortality was 9.5%, with a higher mortality rate in the emergent group (30.6%) than the elective group (3.1%). Conclusions Octogenarians who undergo elective colorectal cancer surgery have better results than those requiring emergent surgery, but both are quite acceptable and we recommend surgical intervention should not be delayed.
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Affiliation(s)
- Guo Ming-Gao
- Department of Surgery, The Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Yishan Road 600, 200233 Shanghai, China.
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Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis 2014; 16:947-56. [PMID: 25039965 DOI: 10.1111/codi.12718] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/17/2014] [Indexed: 02/06/2023]
Abstract
AIM Enhanced recovery after surgery (ERAS) can decrease complications and reduces hospital stay. Less certain is whether elderly patients can fully adhere to and benefit from ERAS. We aimed to determine the safety, feasibility and efficacy of enhanced recovery after colorectal surgery in patients aged ≥ 65 years old. METHOD A systematic search of Medline, EMBASE and Cochrane was performed to identify (i) studies comparing elderly patients managed with ERAS vs traditional care, (ii) cohort studies of ERAS with results of elderly vs younger patients and (iii) any case series of ERAS in elderly patients. End-points of interest were length of hospital stay, complications, mortality, readmission and re-operation, and ERAS protocol adherence. RESULTS Sixteen studies were included. Two randomized controlled trials demonstrated shorter hospital stay in elderly patients with ERAS compared with elderly patients with non-ERAS (9 vs 13.2 days, P < 0.001; 5.5 vs 7 days, P < 0.0001). Fewer complications occurred with ERAS in both randomized controlled trials (27.4% vs 58.6%, P < 0.0001; 5% vs 21.1%, P = 0.045). The majority of observational studies did not show differences in outcome between elderly and younger patients in terms of hospital stay, morbidity or mortality. Inconsistent findings between cohort studies may reflect the disparities in ERAS protocol definitions or differences in study populations. CONCLUSION ERAS can be safely applied to elderly patients to reduce complications and shorten length of hospital stay. Further studies are required to assess whether elderly patients are able to adhere to, and benefit from, ERAS protocols to the same extent as younger patients.
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Affiliation(s)
- N M Bagnall
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Paddington, London, UK
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Park HS, Jung CK, Lee SH, Chae BJ, Lim DJ, Park WC, Song BJ, Kim JS, Jung SS, Bae JS. Clinicopathologic Characteristics and Surgical Outcomes of Elderly Patients with Thyroid Cancer. Jpn J Clin Oncol 2014; 44:1045-51. [DOI: 10.1093/jjco/hyu132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Kim KH, Kim MC, Jung GJ. Is the rate of postoperative complications following laparoscopy-assisted gastrectomy higher in elderly patients than in younger patients? World J Surg Oncol 2014; 12:97. [PMID: 24736010 PMCID: PMC3990240 DOI: 10.1186/1477-7819-12-97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 04/07/2014] [Indexed: 01/12/2023] Open
Abstract
Background With an increase in life expectancy, very elderly patients are presenting with gastric cancer more commonly than ever. The present study retrospectively analyzed the surgical outcomes of laparoscopy-assisted gastrectomy for gastric cancer in the young, elderly, and very elderly age groups. Methods The study group consisted of 1,055 patients who underwent laparoscopy-assisted gastrectomy between February 2002 and December 2012. We divided these patients into three groups; group 1 (young age, <65 years), group 2 (elderly age, 65–74 years), and group 3 (very elderly age, ≥75 years). Results There were statistical differences in the rates of postoperative complications among the three groups (P = 0.008). However, when assessed according to the severity of postoperative complications based on the Clavien-Dindo classification, there was no statistical difference among the three groups (P = 0.562). Conclusions Laparoscopy-assisted gastrectomy for gastric cancer can be performed in very elderly patients. In analyzing studies of elderly patients with postoperative complications following the procedure, not only should the rate of postoperative complications be taken into consideration, but also the severity of any postoperative complications.
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Affiliation(s)
| | - Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, 3-1 Dongdaeshin-Dong, Seo-Gu, Busan 602-715, Korea.
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Ugolini G, Ghignone F, Zattoni D, Veronese G, Montroni I. Personalized surgical management of colorectal cancer in elderly population. World J Gastroenterol 2014; 20:3762-3777. [PMID: 24833841 PMCID: PMC3983435 DOI: 10.3748/wjg.v20.i14.3762] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/09/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population. In this phase of the life cycle, treatment is frequently suboptimal. Despite the fact that, nowadays, older people tend to be healthier than in previous generations, surgical undertreatment is frequently encountered. On the other hand, surgical overtreatment in the vulnerable or frail patient can lead to unacceptable postoperative outcomes with high mortality or persistent disability. Unfortunately, due to the geriatric patient being traditionally excluded from randomized controlled trials for a variety of factors (heterogeneity, frailty, etc.), there is a dearth of evidence-based clinical guidelines for the management of these patients. The objective of this review was to summarize the most relevant clinical studies available in order to assist clinicians in the management of CRC in the elderly. More than in any other patient group, both surgical and non-surgical management strategies should be carefully individualized in the elderly population affected by CRC. Although cure and sphincter preservation are the primary goals, many other variables need to be taken into account, such as maintenance of cognitive status, independence, life expectancy and quality of life.
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Ahmed S, Howel D, Debrah S. The influence of age on the outcome of treatment of elderly patients with colorectal cancer. J Geriatr Oncol 2014; 5:133-40. [PMID: 24495704 DOI: 10.1016/j.jgo.2013.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/22/2013] [Accepted: 12/31/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We investigated factors associated with post-operative mortality rates in those aged ≥60, and in particular, the relative survival of age bands within this group. METHODS Secondary analysis of a large comprehensive cohort of the elderly treated for colorectal cancer in the North of England during 1998-2003. We investigated seven risk factors associated with 30-day and 6-month post-operative mortality from colorectal surgery. RESULTS 6083 patients aged ≥60 underwent colorectal cancer surgery. Approximately 8% had died within 30 days of surgery and 17% had died within 6 months. Thirty-day mortality was greater in the elderly (80 years+) compared to the young-old (60-69 years) (adjusted OR: 3.2, 95% CI 2.4 to 4.4). There was neither a significant difference between the proportions offered curative resections across the age-groups, nor was there a significant association between intent of surgery and 30-day mortality. Six-month mortality rose with age, but the association was stronger in those having curative surgery (adjusted OR: 3.8, 95% CI 2.8 to 5.2) than palliative surgery (adjusted OR: 1.5, 95% CI 1.1 to 2.1). Mortality from emergency surgery at 6-months was particularly high in elderly females. CONCLUSIONS This large population study adds more weight to the findings that age itself is a major risk factor in the outcome of colorectal surgery in elderly and that 30-day mortality underestimates the longer-term outcome in this age group. There was no significant association between radical resections and 30-day mortality in elderly patients compared to the younger age groups; however, a disproportionately higher mortality at 6 months was seen in elderly female patients.
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Affiliation(s)
- Sohail Ahmed
- Darlington Memorial Hospital, Hollyhurst Road, Darlington DL3-6HX, UK.
| | - Denise Howel
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne NE2-4AX, UK.
| | - Samuel Debrah
- Darlington Memorial Hospital, Darlington DL3-6HX, UK.
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Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients: a systematic review. Lancet Oncol 2013. [PMID: 23182193 DOI: 10.1016/s1470-2045(12)70378-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Elderly people represent almost all patients diagnosed with and treated for rectal cancer, and this trend is likely to become more apparent in the future. Surgical management and treatment decisions for this disease are becoming increasingly complex, but only a few reports deal specifically with older patients. In this systematic review, we provide an overview of published studies of outcomes after curative surgery for rectal cancer in elderly people (>70 years). We identified 48 studies providing information about postoperative results, survival, surgical approach, stoma formation, functional results, and quality of life after rectal resection for cancer. We found that advanced chronological age should not, by itself, exclude patients from curative rectal surgery or from other surgical options that are available for younger patients. Although overall survival is lower in elderly patients than in younger patients, cancer-specific survival does not decrease with age. However, the level of evidence for most studies was weak, emphasising the need for high-quality clinical trials for this population.
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Chang HR, Shih SC, Lin FM. Impact of Comorbidities on the Outcomes of Older Patients Receiving Rectal Cancer Surgery. INT J GERONTOL 2012. [DOI: 10.1016/j.ijge.2012.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mamidanna R, Almoudaris AM, Faiz O. Is 30-day mortality an appropriate measure of risk in elderly patients undergoing elective colorectal resection? Colorectal Dis 2012; 14:1175-82. [PMID: 21999306 DOI: 10.1111/j.1463-1318.2011.02859.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIM The study aimed to define mortality in the elderly following elective colorectal resection and to identify the most meaningful postoperative period to report mortality rates in this group of patients. METHOD A systematic review was undertaken to identify studies that reported on mortality in the elderly following elective colorectal resection. Searches of MEDLINE, Embase and PubMed databases were carried out by two independent reviewers and the results were collated. Two reviewers conducted literature searches independently and the third reviewer acted as an arbiter in case of discordance. RESULTS Two-hundred and thirty-six studies published in 2000 or later were identified in the search. Studies were excluded if they included emergency surgery, included patients receiving surgery before 1995, or did not comment on mortality in an elderly age group. Seventeen studies were finally included in the review. Thirty-day or postoperative mortality rates varied from 0 to 13.3%. Short-term mortality was low in elderly patients selected for minimal access surgery. National population and registry observational audits reported higher short-term mortality rates than most small case series or cohort studies. One national audit demonstrated that a significant mortality risk persists for up to 1 year after surgery. CONCLUSION Historical case series suggest that 30-day mortality following colorectal resection in the elderly is low. The reliability of 30-day mortality measures to reflect surgical success in this cohort is, however, questionable as a significant proportion of patients die in the months following surgery.
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Affiliation(s)
- R Mamidanna
- Department of Surgery and Cancer, Imperial College, St Mary's Hospital, South Wharf Road, London W21NY, UK
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Pawa N, Cathcart PL, Arulampalam THA, Tutton MG, Motson RW. Enhanced recovery program following colorectal resection in the elderly patient. World J Surg 2012; 36:415-23. [PMID: 22146943 DOI: 10.1007/s00268-011-1328-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The enhanced recovery program (ERP) aims to reduce the metabolic response to surgery, hastening recovery and shortening hospital stay. Concerns exist regarding morbidity and hospital stay in elderly patients. The present study aimed to compare the outcomes and compliance of elderly patients managed by an ERP protocol with a younger group. METHODS A review was performed of a prospective database of patients undergoing colorectal resection managed under the ERP protocol between 2005 and 2010. Patients were grouped into <80 years and ≥ 80 years, and perioperative data were collated. The postoperative outcomes were compared with the goals set out by the ERP protocol. RESULTS A total of 688 patients were included, 558 were <80 years (median: 66 years; range: 17-79 years) and 130 were ≥ 80 years (median: 83 years; range: 80-95 years). Some 96% of operations were planned laparoscopically. Median total length of hospital stay was 6 days (range: 1-108 days) for the <80 year group and 8 days (range: 1-167 days; P 0.363) for the elderly group, with a 30 day readmission rate of 8.6% for the population and no significant differences between groups. The 30 day mortality was 5%, with a significant difference between the two groups (P < 0.0001). Differences in protocol adherence were identified in the discontinuation of intravenous fluids, catheter removal, and early mobilization. CONCLUSIONS An enhanced recovery program is feasible for colorectal surgery patients ≥ 80 years of age, with similar compliance as the younger group to some aspects of the protocol and an acceptable readmission rate. Attention to improving compliance in the postoperative phase is necessary, particularly in such high-risk patients, as such improvement may reduce the morbidity and mortality.
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Affiliation(s)
- Nikhil Pawa
- ICENI Centre, Colchester Hospital University NHS Foundation Trust, Turner Road, Colchester, Essex, CO4 5JL, UK.
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Campos FG, Calijuri-Hamra MC, Imperiale AR, Kiss DR, Nahas SC, Cecconello I. Locally advanced colorectal cancer: results of surgical treatment and prognostic factors. ARQUIVOS DE GASTROENTEROLOGIA 2012; 48:270-5. [PMID: 22147133 DOI: 10.1590/s0004-28032011000400010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 07/27/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the incidence surgical results and prognostic factors of locally advanced colorectal cancer. METHODS Cohort study including 679 colorectal cancer patients treated from 1997 to 2007. Clinical, surgical and histological data were analyzed. RESULTS Ninety patients (females 61%; median age 59 years) were treated for locally advanced carcinomas (13.2%), either in the colon (66%) or rectum (34%). Extended resections most commonly involved the small bowel (19.8%), bladder (16.4%), uterus (12.9%) and ovaries (11.2%). Postoperative morbidity and mortality occurred in 23 (25.6%) and 3 (3.3%) patients, respectively. Survival and recurrence analysis among 76 R0 (84.4%) procedures revealed a 60% 5-year survival and 34% local recurrence rates. Survival curves demonstrated reduced rates for rectal location (45% vs 65%), tumor depth (50% for T4 vs 75% for T3), vascular/ lymphatic/perineural invasion (35% vs 80%) and lymph node metastasis (35% vs 80%). CONCLUSIONS Locally advanced carcinomas were found in 13.2% of patients. Survival rates were negatively affected by rectal location and adverse histological features. Number of involved organs and neoplastic adhesions did not influenced chances of survival. A radical R0 extended resection was achieved in a high proportion of cases, resulting in a 60% cancer-free survival under acceptable operative risks.
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Affiliation(s)
- Fábio Guilherme Campos
- Unidade Colorretal, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.
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Mantke R, Schmidt U, Wolff S, Kube R, Lippert H. Incidence of synchronous liver metastases in patients with colorectal cancer in relationship to clinico-pathologic characteristics. Results of a German prospective multicentre observational study. Eur J Surg Oncol 2011; 38:259-65. [PMID: 22209659 DOI: 10.1016/j.ejso.2011.12.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 09/22/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND The aim of this prospective observational multicentre study was to evaluate the incidence of synchronous liver metastases in colon and rectal cancer and to determine clinico-pathologic factors of the colorectal cancer that influenced the development of synchronous liver metastases. METHODS Of 48,894 patients with colorectal cancer and who underwent surgery between January 2000 and December 2004, 7209 developed hepatic metastases and were analyzed. RESULTS Synchronous liver metastases occurred in 14.7% of the colorectal cancer cases. Colon cancer (15.4%) led significantly more frequently to haematogenous spread to the liver than rectal cancer (13.5%) in a univariate approach. The N, V, and T stage, as well as the number of metastatic-involved local lymph nodes independently influenced the frequency of synchronous liver metastases in colon and rectal cancer in a multivariate analysis. Localization of the cancer in the colon led to a different number of synchronous liver metastases. Localization of the rectal cancer did not influence the rate of synchronous liver metastases. In the case of synchronous liver metastases, patients with colon cancer had significantly more peritoneal metastases (17.9 vs. 9.15%) but less lung (9.7 vs. 14%) and bone (0.7 vs. 1.6%) metastases. Simultaneous curative liver resections were done in 7% of colon cancer cases and in 8.8% of rectal cancer cases. CONCLUSION In this national study the incidence of synchronous liver metastases in colon and rectal cancer were different. Independent factors leading to synchronous liver metastases could be identified. Venous infiltration seems to be important for the development of distant metastases.
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Affiliation(s)
- R Mantke
- Department of Surgery, Institute for Quality Control in Surgery, Otto-von-Guericke-University of Magdeburg, Germany.
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