Surgical treatment of colorectal cancer in patients aged over 80 years

Post-operative outcomes in the elderly following colorectal cancer surgery

BACKGROUND

Despite the prevalence of colorectal cancer in the elderly, there has been a lack of recent studies examining surgical outcomes in these patients. Post-operative outcomes of colorectal cancer surgeries in those aged 80 and above will be compared to those younger than 80.

METHODS

A retrospective study was conducted of adults receiving surgical resections at a single tertiary centre for colorectal cancer diagnosed between January 2017 and December 2019. Patient demographics, mode of presentation, tumour demographics, operative data and post-operative outcomes were investigated.

RESULTS

Of the 326 patients included, 56 were aged 80 and above. Older patients were more likely to be female (P = 0.02), present with surgical emergencies or from other workup rather than through screening (P = 0.002), have more locally advanced cancers (P = 0.009) and receive less neoadjuvant therapy (P = 0.016). Despite this, they had comparable outcomes to those younger than 80 in terms of length of stay (P = 0.21) and rates of complications including mortality (P = 0.67).

CONCLUSION

With appropriate patient selection and management, elderly patients can achieve comparable post-operative outcomes to their younger counterparts.

Long-Term Survival in Octogenarians After Surgical Treatment for Colorectal Cancer: Prevention of Postoperative Complications is Key

Background

Whether to treat octogenarians with colorectal cancer (CRC) in the same manner as younger patients remains a challenging issue. The purpose of this study was to analyse postoperative complications and long-term survival in a consecutive cohort of octogenarians who were surgically treated for CRC.

Methods

Octogenarians with primary CRC suitable for curative surgery between January 2008 and December 2011 were included. Data about comorbidities, tumour stage, and complications were retrospectively collected from patient files. Data about survival were retrieved with use of the Dutch database for persons and addresses. To identify factors associated with severe postoperative complications and postoperative survival, logistic regression analyses, and Cox regression analyses were performed. Odds ratios and hazard ratios (HR) with 95% confidence intervals (CI) were estimated.

Results

In a series of 108 octogenarians, median age was 83 years (range 80–94 years). Median follow-up was 47 (range 1–107) months. Major postoperative complications occurred in 25% of the patients. No risk factors for development of severe postoperative complications could be identified. The 30-day mortality was 7%; 1- and 5-year mortality was 19% and 56%, respectively. Overall median survival was 48 months: 66 months in patients without complications versus 13 months in patients with postoperative complications. Postoperative complications were most predictive of decreased survival (HR 3.16; 95% CI 1.79–5.59), even including tumour characteristics, comorbidity, and emergency surgery.

Conclusions

Long-term survival in octogenarians deemed fit for surgery is reasonably good. Prevention of major postoperative complications could further improve clinical outcome.

Surgery for colorectal cancer in elderly patients: how can we improve outcome?

PURPOSE

Patients over 70 years of age are characterised by diminished long-term survival rates following resection of colorectal cancer (CRC) compared to younger patients. The aim of this study was to clarify whether reduced survival is a result of malignancy, comorbidities or the treatment received.

METHODS

All patients with CRC, who were admitted to our institution over a period of 10 years, were selected from a prospectively maintained database. Disease-specific, disease-free and overall survival rates were calculated dependent on variables considered potentially relevant for the patients' prognosis.

RESULTS

915 patients were included in the study. Observed 5- and 10-year survival rates for the whole group were 48 ± 2% and 40 ± 2%, respectively, but 10-year survival rates dropped to 14 ± 4% for patients aged 80 and older. Resection of the primary tumour was attempted in all cases independent of age. Emergency admission, Charlson index ≥2, ECOG ≥2, old age, second malignancies, distant metastases, high grading and non-resective surgery were identified as independent prognostic parameters associated with decreased overall survival. In contrast, disease-specific and disease-free survival rates for patients after elective radical resection in UICC-stage I-III did not show significant differences related to age. Tumour site, UICC-stage and resection status were independent statistically significant predictors of disease-specific survival.

CONCLUSIONS

Similar disease-specific survival rates in all age groups speak in favour of tumour resection in curative intent even in old patients. Better outcome may be achieved, if regular screening for colorectal cancer is considered even in the elderly to avoid late presentation requiring emergency surgery.

[Colorectal cancer: prevention and curative treatment in the elderly: An appraisal from the viewpoint of geriatric gastroenterology]

BACKGROUND

More than half of colorectal cancers occur in patients older than 75 years. This group is not homogeneous but variably vulnerable to disease, diagnostics, treatment procedures and complications.

OBJECTIVES

This review highlights the age-specific aspects of diagnostics and screening, curative and adjuvant treatment and the prognostic and predictive value of a geriatric assessment.

METHODS

A survey was carried out based on a selection of the relevant literature.

RESULTS

The number of publications is currently rapidly increasing and even now it becomes apparent that a geriatric assessment carried out by the primary physician, can better predict therapy-linked adverse events and allow for a more individualized assessment of indications for diagnostics and screening of surgical and medicinal treatment. In particular this applies to total mesorectal resection and to the adjuvant use of oxaliplatin.

CONCLUSION

Even in the older age group screening colonoscopy and surgical and medicinal adjuvant treatment can be reasonably used when aligned to the results of a carefully performed geriatric assessment. A severely reduced life-expectancy (generally with more than 2 comorbidities) should lead to more conservative approaches.

Verbascoside exerts therapeutic effects against colorectal cancer xenografts in nude mice via HIPK2-P53 pathway

AIM: To investigate whether verbascoside exerts therapeutic effects against colorectal cancer xenografts in nude mice and the possible role of the HIPK2-P53 pathway in this process.

METHODS: An ectopic nude mice model of colorectal cancer was established by subcutaneously inoculating human colorectal carcinoma HCT-116 cells into the armpit of nude mice. The mice were then randomly divided into 5 groups: a model control group, low- [20 mg/(kg·d)], medium- [40 mg/(kg·d)], high-dose verbascoside groups [80 mg/(kg·d)], and a 5-fluorouracil (5-FU) group [1 mg/(kg·d)]. Drugs were injected intraperitoneally for two weeks. Two weeks later, the mice were sacrificed and the tumors were peeled off to measure tumor size and weight. The expression of apoptosis-related proteins HIPK2, P53, Bax, and Bcl-2 in tumor tissues was tested by immunohistochemistry.

RESULTS: Compared with the model control group, tumor size decreased by 48.41%, 61.04%, 63.75%, and 75.14% in the low-, medium-, high-dose verbascoside groups and the 5-FU group, respectively, and tumor weight decreased by 42.79%, 53.90%, 60.99%, and 66.19%. The relative expression levels of HIPK2 in tumor tissues were 4.83 ± 0.62, 8.46 ± 0.99, 11.90 ± 1.21 and 13.50 ± 0.94, in the low-, medium-, high-dose verbascoside groups and the 5-FU group, respectively. The corresponding values were 14.59 ± 0.90, 17.60 ± 1.40, 23.10 ± 2.10 and 22.44 ± 2.05 for P53, 14.41 ± 0.38, 15.84 ± 0.54, 26.28 ± 0.55 and 26.34 ± 2.33 for Bax, and 14.08 ± 1.04, 11.93 ± 0.93, 7.48 ± 0.86 and 5.46 ± 0.67 for Bcl-2.

CONCLUSION: Verbascoside can inhibit the growth of human colorectal cancer xenografts in mice, up-regulate the expression of HIPK2, P53 and Bax, and down-regulate Bcl-2 expression. The inhibition of colorectal cancer by verbascoside was closely with the promotion of tumor cell apoptosis.