Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection

Short-term efficacy of laparoscopic radical resection for colorectal cancer and risk of unplanned reoperation after surgery

BACKGROUND

Surgery is the first choice of treatment for patients with colorectal cancer. Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions. With the continuous development of medical technology, laparoscopic minimally invasive surgery has shown great advantages for the treatment of patients with celiac disease.

AIM

To investigate the short-term efficacy of laparoscopic radical surgery and traditional laparotomy for the treatment of colorectal cancer, and the differences in the risk analysis of unplanned reoperation after operation.

METHODS

As the research subjects, this study selected 100 patients with colorectal cancer who received surgical treatment at the Yulin First Hospital from January 2018 to January 2022. Among them, 50 patients who underwent laparoscopic radical resection were selected as the research group and 50 patients who underwent traditional laparotomy were selected as the control group. Data pertaining to clinical indexes, gastrointestinal hormones, nutrition indexes, the levels of inflammatory factors, quality of life, Visual Analog Scale score, and the postoperative complications of the two groups of patients before and after treatment were collected, and the therapeutic effects in the two groups were analyzed and compared.

RESULTS

Compared with the control group, perioperative bleeding, peristalsis recovery time, and hospital stays were significantly shorter in the research group. After surgery, the levels of gastrin (GAS) and motilin (MTL) were decreased in both groups, and the fluctuation range of GAS and MTL observed in the research group was significantly lower than that recorded in the control group. The hemoglobin (Hb) levels increased after surgery, and the level of Hb in the research group was significantly higher compared with the control group. After the operation, the expression levels of tumor necrosis factor-α, interleukin-6, and C-reactive protein and the total incidence of complications were significantly lower in the research group compared with the control group. One year after the operation, the quality of life of the two groups was greatly improved, with the quality of life in the research group being significantly better.

CONCLUSION

Laparoscopy was effective for colorectal surgery by reducing the occurrence of complications and inflammatory stress reaction; moreover, the quality of life of patients was significantly improved, which warrants further promotion.

Predictors of perioperative morbidity in elderly patients undergoing colorectal cancer resection

AIM

Colorectal cancer resection in the elderly may be associated with significant morbidity. This study aimed to assess perioperative morbidity in elderly patients undergoing colorectal cancer resection and to investigate risk factors for postoperative complications.

MATERIALS AND METHODS

Consecutive patients aged ≥ 75 years undergoing colorectal cancer resection with curative intent between January 2014 and December 2021 at our institution were included. We evaluated risk factors for postoperative complications, length of hospital stays (LOS), 30-day readmission, and 90-day mortality rates.

RESULTS

A total of 843 patients underwent colorectal cancer resection during the study period, of whom 202 patients were 75 years or older. Advanced age was associated with postoperative complications (Clavien-Dindo score > 3b, p = 0.001). Sarcopenia, preoperative plasma albumin < 3.5 g/dL, and open and urgent surgery were significantly correlated with major complications (p = 0.015, p = 0.022, p = 0.003, and p < 0.001, respectively). LOS was longer in elderly patients with a modified 5-item Frailty Index (5-mFI) ≥ 2 and low preoperative serum albumin levels, as well as following open surgery (p = 0.006, p = 0.001 and p < 0.001, respectively). Sarcopenia and preoperative plasma albumin < 3.5 g/dL were predictors for 90-day mortality (p = 0.004 and p > 0.001).

CONCLUSION

Advanced age, sarcopenia, preoperative hypoalbuminemia, 5-mFI ≥ 2, and open or urgent surgery may serve as predictors for postoperative morbidity in the elderly population.

Application effect of preoperative chemoradiotherapy combined with rehabilitation nursing in patients with rectal cancer surgery

To study the effect of preoperative chemoradiotherapy combined with rehabilitation nursing in patients with rectal cancer surgery. 106 cases of rectal cancer patients in our hospital were selected. 53 cases in each group were treated with surgical treatment combined with rehabilitation nursing treatment and preoperative radiotherapy and chemotherapy combined with surgical treatment and rehabilitation nursing treatment in the study group. The T stage (ypT) and N stage (ypN) downgrading rates of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 were compared between the two groups after treatment. The 5-year cumulative survival rate, recurrence rate and the positive rate of Bax and antigen identified by monoclonal antibody Ki-67 (Ki-67) expression were detected. T stage downgrading rate and N stage downgrading rate were 77.36% (41/53) 35.85% (19/53) in control group and 94.34% (50/53) 64.15% (34/53) in research group, respectively. The CEA and CA19-9 levels measured at the end of surgery and one month after nursing in both groups were lower than those before treatment. After treatment, scores of quality of life indicators in both groups increased. The positive rates of Bax and Ki-67Ki-67 were significantly different between the two groups after treatment (P < 0.05). Preoperative chemoradiotherapy combined with rehabilitation nursing has obvious effect on patients with rectal cancer surgery, and has obvious advantages in inhibiting tumor growth, destroying tumor survival immune environment and reducing surgical complications, which can improve the prognosis and is worthy of clinical application. It could provide a potential treatment for patients with rectal cancer.

Comparative Analysis of Laparoscopic Versus Open Surgery in Colorectal Cancer: An Eight-Year Single-Center Experience From Jordan

Introduction The use of laparoscopic surgery has increased in the treatment of colorectal cancer (CRC). However, achieving oncological outcomes similar to those of open surgery remains challenging, particularly for CRC. In this comparative, retrospective study, we aim to investigate and compare the postoperative complications of open and laparoscopic CRC surgery in Jordan. Methods Using a retrospective study design, patients' records were obtained from the electronic hospital database of King Hussein Medical Center, Amman, Jordan, during the period between 2016 and 2024. Demographic data were collected for age and gender. Clinical data were collected for tumor site, tumor grade, body mass index, American Society of Anesthesiologists (ASA) score, lymph node ratio (LNR), postoperative complications such as ileus, anastomosis, stoma, renal complications, pain, wound infection, and death, and length of hospital stay. Results We included 857 CRC patients, with 437 (51.0%) undergoing laparoscopic resection and 420 (49%) undergoing open resection. The mean age was 58 years, with no age difference between the study groups. Most patients (507, 59%) were in good health based on the ASA score. The majority (671, 78%) had moderately differentiated tumors, with 320 (76%) in the open surgery group and 351 (80%) in the laparoscopy group. The mean LNR was 0.19, trending higher in the group that underwent open surgery (0.33 vs. 0.09, p = 0.065). The open surgery group had a significantly longer hospital stay (5.28 days) relative to the laparoscopic group (3.77 days, p < 0.001). Postoperative complications included wound infection (33, 3.9%), ileus (19, 2.2%), stoma (15, 1.8%), anastomosis (10, 1.2%), renal complications (9, 1.1%), and pain (6, 0.7%). The mortality rate was higher in the open surgery group (p = 0.035). Most patients (711, 83%) did not experience postoperative complications. Conclusion This is the first Jordanian study to compare long-term outcomes of CRC patients undergoing open versus laparoscopic surgical resection. Our findings suggested that the laparoscopic group had a shorter hospital stay, with no differences in postoperative complications rate between the study groups. Mortality rates were low overall but significantly higher in the open surgery group. These results suggest that laparoscopic resection may be superior for CRC surgery, though further multicenter studies are warranted to confirm our findings.

Five-item Modified Frailty Index in Elderly Patients Undergoing Laparoscopic Colorectal Surgery Predicts Postoperative Complications

Background/Aim

Owing to underlying diseases and decreased physiological functions, frailty in elderly patients may be associated with adverse postoperative complications and mortality. To date, there are various frailty assessment methods, with the five-item modified frailty index (mFI-5) being an objective and concise evaluation tool. This study aimed to clarify whether mFI-5 scoring, a measure of frailty, can predict postoperative outcomes in elderly patients undergoing laparoscopic colorectal surgery.

Patients and Methods

A total of 107 patients aged over 80 years who underwent laparoscopic colorectal surgery at Nagasaki University Hospital between 2011 and 2018 were included in this study. The mFI-5 was used to assess the preoperative condition of each patient, with scores compared against various postoperative outcome measures. Univariate analysis was used to determine between-group differences for pre- and post-operative variables.

Results

Of the 107 patients [median age, 83 (80-99) years], 44.9% were male. The mFI-5 score was calculated and patients were divided into three groups: 0 (n=36, 33.6%); 1 (n=44, 41.1%); and 2+ (n=27, 25.3%). The groups were significantly associated with the American Society of Anesthesiology (ASA) classification (p<0.001). Postoperative complications occurred in 43 patients (40.2%), and a higher mFI-5 score was significantly associated with postoperative complications of Clavien-Dindo grade ≥III and duration of hospital stay.

Conclusion

The mFI-5 is an objective and useful tool for predicting postoperative complications of laparoscopic surgery in elderly patients with colorectal cancer.

Short- and long-term outcomes of laparoscopic right hemicolectomy with D3 resection for right colon cancer in elderly patients

BACKGROUND

Laparoscopic right hemicolectomy (RHC) with D3 resection, similar to complete mesocolic excision, is an oncologically satisfying procedure; however, it remains controversial in elderly patients. There are no reports of the procedure for tumors fed by middle colic vessels because it is a difficult procedure. We evaluated the feasibility and oncological outcomes of the procedure in elderly patients.

METHODS

We retrospectively evaluated 336 consecutive patients undergoing laparoscopic right hemicolectomy with D3 resection for Stage I-III ascending and transverse colon cancer between 2010 and 2021. Patients were divided into the EP (age ≥ 75 years) and nEP (age < 75 years) groups, and short- and long-term outcomes were analyzed using propensity score matching.

RESULTS

The median follow-up period was 60.7 months. After matching, we enrolled 129 patients. The surgery time, estimated blood loss, postoperative complication rate, number of harvested lymph nodes, and recurrence rate did not differ significantly between the groups; however, the adjuvant chemotherapy rate was significantly lower in the EP group. The EP group had significantly shorter overall survival (OS) (p < 0.01) than the nEP group; however, the cancer-specific (p = 0.15) and recurrence-free (p = 0.36) survivals did not differ significantly from those in the nEP group. In multivariate analyses, age ≥ 75 years, ASA ≥ 3, and pT4 were independent prognostic factors for OS (p = 0.02, < 0.01, < 0.01, respectively); however, only pT4 was an independent prognostic factor for CSS and RFS (p < 0.01 for both).

CONCLUSIONS

This procedure offers safe, feasible, and satisfactory oncological outcomes for elderly patients.

EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults

BACKGROUND

As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery.

METHODS

Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology.

RESULT

Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery.

CONCLUSIONS

MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.

Complications and comorbidities associated with antineoplastic chemotherapy: Rethinking drug design and delivery for anticancer therapy

Despite the considerable advancements in chemotherapy as a cornerstone modality in cancer treatment, the prevalence of complications and pre-existing diseases is on the rise among cancer patients along with prolonged survival and aging population. The relationships between these disorders and cancer are intricate, bearing significant influence on the survival and quality of life of individuals with cancer and presenting challenges for the prognosis and outcomes of malignancies. Herein, we review the prevailing complications and comorbidities that often accompany chemotherapy and summarize the lessons to learn from inadequate research and management of this scenario, with an emphasis on possible strategies for reducing potential complications and alleviating comorbidities, as well as an overview of current preclinical cancer models and practical advice for establishing bio-faithful preclinical models in such complex context.

Comparison of Clinical Outcomes Between Laparoscopic and Open Surgery in Colorectal Cancer Patients

Aim

Our research compares the clinical results of open surgery versus laparoscopic surgery for colorectal malignancies.

Materials and Methods

Our analysis focused on a database that included data on patients with colorectal cancer who had laparoscopic or open surgery for stages I to III at a prestigious healthcare institute in India. Two groups of 50 patients underwent laparoscopic and 50 underwent conventional open colorectal surgery (OCRS and LCRS, respectively) throughout the same time. Patient demographics, operation data, initial postoperative outcomes, follow-up appointments, pathology results, and cancer stages were examined.

Results

The LCRS group had a much longer operation time compared to the OCRS. Subjects in the LCRS group experienced a notably accelerated recovery after surgery. The hospital stay for the OCRS group was considerably longer compared to that in the LCRS group.

Conclusion

Laparoscopic colorectal surgery is a reliable and convenient alternative to the traditional open approach, providing comparable oncological efficacy.

Current use of artificial intelligence in the diagnosis and management of acute appendicitis

INTRODUCTION

Acute appendicitis is a common and time-sensitive surgical emergency, requiring rapid and accurate diagnosis and management to prevent complications. Artificial intelligence (AI) has emerged as a transformative tool in healthcare, offering significant potential to improve the diagnosis and management of acute appendicitis. This review provides an overview of the evolving role of AI in the diagnosis and management of acute appendicitis, highlighting its benefits, challenges, and future perspectives.

EVIDENCE ACQUISITION

We performed a literature search on articles published from 2018 to September 2023. We included only original articles.

EVIDENCE SYNTHESIS

Overall, 121 studies were examined. We included 32 studies: 23 studies addressed the diagnosis, five the differentiation between complicated and uncomplicated appendicitis, and 4 studies the management of acute appendicitis.

CONCLUSIONS

AI is poised to revolutionize the diagnosis and management of acute appendicitis by improving accuracy, speed and consistency. It could potentially reduce healthcare costs. As AI technologies continue to evolve, further research and collaboration are needed to fully realize their potential in the diagnosis and management of acute appendicitis.

Evaluation of Laparoscopic Colorectal Resection Among Elderly Individuals With Colorectal Malignancy: A Single-center Retrospective Analysis

OBJECTIVE

The purpose of the current study was to statistically clarify the precise risk age in elderly patients undergoing colorectal surgery and to evaluate the safety and efficacy of laparoscopic colorectal resection in these patients.

METHODS

Patients' clinical variables were extracted from the database of the Gastrointestinal Surgery Centre, Third Affiliated Hospital of Sun Yat-sen University, from 2015 to 2019. Logistic regression was conducted to identify independent risk factors of postoperative complications and ORs for each age. Curves of odds ratios (ORs) and CIs for each age were fitted by using a locally weighted scatterplot smoother, and a structural breakpoint was determined by the Chow test to identify a precise cutoff risk age for elderly patients. Comparison and subgroup analysis were conducted between surgical approach groups using the Student t test and χ 2 analysis.

RESULTS

Locally weighted scatterplot smoother OR analysis manifested that patients aged 69 years old or older suffered a higher possibility of postoperative complications and should be defined as high-risk age. Comparison according to the high-risk age revealed laparoscopic colorectal surgery is better than laparotomic surgery for elderly individuals in terms of hospital stay (9.46 ± 5.96 vs 15.01 ± 6.34, P < 0.05), the incidence of intensive care unit transfer (4 vs 20, P < 0.05), and incidence of surgical site infection (15 vs 20, P < 0.05). Patients who underwent laparotomic surgery had a greater prevalence of Clavien-Dindo II/III complications ( P < 0.05). These findings remained stable even after propensity matching. Furthermore, such superiority was proved especially significant for patients who underwent left-side colorectal resection. In addition, overall survival was improved in the laparoscopic surgery group, whereas no differences were observed in disease-free survival.

CONCLUSION

In our study population, age 69 or older was a cutoff point age suggests a higher possibility of postoperative morbidity after colorectal surgery. Laparoscopic colorectal resection should be regarded as a superior therapeutic choice for these elderly individuals, especially for left-side colorectal surgeries.

Impact of clinical frailty on surgical and non-surgical complications after major emergency abdominal surgery

BACKGROUND

Major emergency abdominal surgery is associated with a high risk of morbidity and mortality. Given the ageing and increasingly frail population, understanding the impact of frailty on complication patterns after surgery is crucial. The aim of this study was to evaluate the association between clinical frailty and organ-specific postoperative complications after major emergency abdominal surgery.

METHODS

A prospective cohort study including all patients undergoing major emergency abdominal surgery at Copenhagen University Hospital Herlev, Denmark, from 1 October 2020 to 1 August 2022, was performed. Clinical frailty scale scores were determined for all patients upon admission and patients were then analysed according to clinical frailty scale groups (scores of 1-3, 4-6, or 7-9). Postoperative complications were registered until discharge.

RESULTS

A total of 520 patients were identified. Patients with a low clinical frailty scale score (1-3) experienced fewer total complications (120 complications per 100 patients) compared with patients with clinical frailty scale scores of 4-6 (250 complications per 100 patients) and 7-9 (277 complications per 100 patients) (P < 0.001). A high clinical frailty scale score was associated with a high risk of pneumonia (P = 0.009), delirium (P < 0.001), atrial fibrillation (P = 0.020), and infectious complications in general (P < 0.001). Patients with severe frailty (clinical frailty scale score of 7-9) suffered from more surgical complications (P = 0.001) compared with the rest of the cohort. Severe frailty was associated with a high risk of 30-day mortality (33% for patients with a clinical frailty scale score of 7-9 versus 3.6% for patients with a clinical frailty scale score of 1-3, P < 0.001). In a multivariate analysis, an increasing degree of clinical frailty was found to be significantly associated with developing at least one complication.

CONCLUSION

Patients with frailty have a significantly increased risk of postoperative complications after major emergency abdominal surgery, especially atrial fibrillation, delirium, and pneumonia. Likewise, patients with frailty have an increased risk of mortality within 90 days. Thus, frailty is a significant predictor for adverse events after major emergency abdominal surgery and should be considered in all patients undergoing major emergency abdominal surgery.

The association of postoperative morbidity and age on 5-year survival after colorectal surgery in the elderly population: a nationwide cohort study

AIM

This study aimed to evaluate the association of age and postoperative morbidity on 5-year overall survival (OS) after elective surgery for colorectal cancer.

METHOD

Patients undergoing elective, curatively intended surgery for colorectal cancer Union for International Cancer Control Stages I-III between January 2014 and December 2019 were selected from four Danish nationwide healthcare databases. Patients were divided into four groups: group I 65-69 years old; group II 70-74 years old; group III 75-79 years old; and group IV ≥80 years old. Propensity score matching was used to reduce potential confounding bias. The primary outcome was the association of age and postoperative morbidity with 5-year OS. The secondary outcome was conditional survival, given that the patient had already survived the first 90 days after surgery.

RESULTS

After propensity score matching with a 1:1 ratio, group II contained 2221 patients; group III 952 patients; and group IV 320 patients. There was no significant difference in 5-year OS between group I (reference) and groups II and III (P = 0.4 and P = 0.9, respectively). Patients with severe postoperative complications within 30 days after surgery had a significantly decreased OS (P < 0.01); however, when patients who died within the first 90 days were excluded from the analysis, the differences in 5-year OS were less pronounced across all age groups.

CONCLUSION

Postoperative morbidity, and not patient age, was associated with a lower 5-year OS. Long-term survival for patients who experience a complication is similar to patients who did not have a complication when conditioning on 90 days of survival.

Impact of Preoperative Neutrophil to Prealbumin Ratio Index (NPRI) on Short-Term Complications and Long-Term Prognosis in Patients Undergoing Laparoscopic Radical Surgery for Colorectal Cancer

Objective

This study aims to evaluate the impact and predictive value of the preoperative NPRI on short-term complications and long-term prognosis in patients undergoing laparoscopic radical surgery for colorectal cCancer (CRC).

Methods

A total of 302 eligible CRC patients were included, assessing five inflammation-and nutrition-related markers and various clinical features for their predictive impact on postoperative outcomes. Emphasis was on the novel indicator NPRI to elucidate its prognostic and predictive value for perioperative risks.

Results

Multivariate logistic regression analysis identified a history of abdominal surgery, prolonged surgical duration, CEA levels ≥5 ng/mL, and NPRI ≥ 3.94 × 10-2 as independent risk factors for postoperative complications in CRC patients. The Clavien--Dindo complication grading system highlighted the close association between preoperative NPRI and both common and severe complications. Multivariate analysis also identified a history of abdominal surgery, tumor diameter ≥5 cm, poorly differentiated or undifferentiated tumors, and NPRI ≥ 2.87 × 10-2 as independent risk factors for shortened overall survival (OS). Additionally, a history of abdominal surgery, tumor maximum diameter ≥5 cm, tumor differentiation as poor/undifferentiated, NPRI ≥ 2.87 × 10-2, and TNM Stage III were determined as independent risk factors for shortened disease-free survival (DFS). Survival curve results showed significantly higher 5-year OS and DFS in the low NPRI group compared to the high NPRI group. The incorporation of NPRI into nomograms for OS and DFS, validated through calibration and decision curve analyses, attested to the excellent accuracy and practicality of these models.

Conclusion

Preoperative NPRI independently predicts short-term complications and long-term prognosis in patients undergoing laparoscopic colorectal cancer surgery, enhancing predictive accuracy when incorporated into nomograms for patient survival.

Effect of screening colonoscopy frequency on colorectal cancer mortality in patients with a family history of colorectal cancer

BACKGROUND

Colorectal cancer is a common malignant tumor in China, and its incidence in the elderly is increasing annually. Inflammatory bowel disease is a group of chronic non-specific intestinal inflammatory diseases, including ulcerative colitis and Crohn's disease.

AIM

To assess the effect of screening colonoscopy frequency on colorectal cancer mortality.

METHODS

We included the clinicopathological and follow-up data of patients with colorectal cancer who underwent laparoscopic colectomy or open colectomy at our Gastrointestinal Department between January 2019 and December 2022. Surgical indicators, oncological indicators, and survival rates were compared between the groups. The results of 104 patients who met the above criteria were extracted from the database (laparoscopic colectomy group = 63, open colectomy group = 41), and there were no statistically significant differences in the baseline data or follow-up time between the two groups.

RESULTS

Intraoperative blood loss, time to first ambulation, and time to first fluid intake were significantly lower in the laparoscopic colectomy group than in the open colectomy group. The differences in overall mortality, tumor-related mortality, and recurrence rates between the two groups were not statistically significant, and survival analysis showed that the differences in the cumulative overall survival, tumor-related survival, and cumulative recurrence-free rates between the two groups were not statistically significant.

CONCLUSION

In elderly patients with colorectal cancer, laparoscopic colectomy has better short-term outcomes than open colectomy, and laparoscopic colectomy has superior long-term survival outcomes compared with open colectomy.

Short- and Long-Term Survival among Elderly Colorectal Cancer Patients in Finland, 2006-2015: A Nationwide Population-Based Registry Study

This population-based registry study aimed to report 30-day and one-year postoperative survival, five-year overall survival (OS), and disease-specific survival (DSS) among elderly (≥75 years old) colorectal cancer (CRC) patients. All new colorectal cancer cases from 2006-2015 were included and followed until death or the end of follow-up (end of 2016). Among 27,088 CRC patients, 11,306 patients were ≥75 years old. Among patients ≥ 75 years, 36.8% (n = 4160) had right-sided colon cancer, 21.9% (n = 2478) left-sided colon cancer, and 32.3% (n = 3650) rectal cancer. In this study population, 932 patients were aged ≥ 90. The 30-day postoperative OS for patients aged 75-79 was 96.1% (95% confidence interval [CI] 95.3-96.9) falling to 93.2% (95% CI 92.0-94.4) for patients aged 80-84. The one-year postoperative OS among patients aged 75-79 was 86.3% (95% CI 84.7-87.9) compared with 80.5% (95% CI 78.7-82.3) among patients aged 80-84. Five-year OS among patients aged 75-79 was 47.6% (95% CI 46.0-49.2) and 36.6% (95% CI 34.8-38.4) among patients aged 80-84, compared with 61.7% (95% CI 60.9-62.5) among younger patients (<75 years old). Survival among elderly CRC patients (≥75 years old) was in general fairly good when compared with younger patients, especially among patients aged 75-79 and 80-84 with localized or locally advanced disease.

Laparoscopic radical surgery for locally advanced T4 transverse colon cancer and prognostic factors analysis: Evidence from multi-center databases

The safety and efficacies of laparoscopic radical procedures are still controversial for locally advanced pathological T4 (pT4) TCC (transverse colon cancer). Therefore, the aim of this study is to evaluate the oncologic and perioperative outcomes and to recognize the prognostic factors in radical resection for pT4 TCC derived from multi-center databases. 314 patients with TCC who underwent radical resection between January 2004 and May 2017, including 139 laparoscopic resections and 175 open resections, were extracted from multicenter databases. Oncological as well as perioperative outcomes were investigated. The baseline characteristics of the 2 groups did not differ significantly. Nevertheless, the laparoscopic technique was found to be linked with a significantly longer duration of surgery (208.96 vs 172.89 minutes, P = .044) and a significantly shorter postoperative hospital stay (12.23 vs 14.48 days, P = .014) when compared to the conventional open approach. In terms of oncological outcomes, lymph node resection (16.10 vs 13.66, P = .886), 5-year overall survival (84.7% vs 82.7%, P = .393), and disease-free survival (82.7% vs 83.9%, P = .803) were similar between the 2 approaches. Based on multivariate analysis, it was determined that differentiation and N classification were both independent prognostic factors for overall survival. However, it was found that only N classification was an independent prognostic factor for disease-free survival. These findings underscore the significance of differentiation and N classification as key determinants of patient outcomes in this context. Overall, the laparoscopic approach may offer advantages in terms of shorter hospital stays, while maintaining comparable oncological outcomes. Laparoscopic radical procedure can gain a couple of short-term benefits without reducing long-term oncological survival for patients with pT4 TCC.

Impact of curcumin on ferroptosis-related genes in colorectal cancer: Insights from in-silico and in-vitro studies

Colorectal cancer (CRC) is responsible for a significant number of cancer-related fatalities worldwide. Researchers are investigating the therapeutic potential of ferroptosis, a type of iron-dependent controlled cell death, in the context of CRC. Curcumin, a natural compound found in turmeric, exhibits anticancer properties. This study explores the effects of curcumin on genes related to ferroptosis (FRGs) in CRC. To gather CRC data, we used the Gene Expression Profiling Interactive Analysis (GEPIA) and Gene Expression Omnibus (GEO) databases, while FRGs were obtained from the FerrDb database and PubMed. We identified 739 CRC differentially expressed genes (DEGs) in CRC and discovered 39 genes that were common genes between FRGs and CRC DEGs. The DEGs related to ferroptosis were enriched with various biological processes and molecular functions, including the regulation of signal transduction and glucose metabolism. Using the Drug Gene Interaction Database (DGIdb), we predicted drugs targeting CRC-DEGs and identified 17 potential drug targets. Additionally, we identified eight essential proteins related to ferroptosis in CRC, including MYC, IL1B, and SLC1A5. Survival analysis revealed that alterations in gene expression of CDC25A, DDR2, FABP4, IL1B, SNCA, and TFAM were associated with prognosis in CRC patients. In SW480 human CRC cells, treatment with curcumin decreased the expression of MYC, IL1B, and EZH2 mRNA, while simultaneously increasing the expression of SLCA5 and CAV1. The findings of this study suggest that curcumin could regulate FRGs in CRC and have the potential to be utilized as a therapeutic agent for treating CRC.

The predictive value of comorbidities on postoperative complication rates and overall survival in left-sided oncological colorectal resections: a multicentre cohort study

INTRODUCTION

Surgical- and nonsurgical complications significantly worsen postoperative outcomes, and identification of patients at risk is crucial to improve care. This study investigated whether comorbidities, graded by the Charlson Comorbidity Index (CCI), impact complication rates and impair long-term outcome in a cohort of left-sided colorectal resections.

METHODS

Retrospective analysis of patients undergoing oncological left-sided colorectal resections due to colorectal cancer between 01/2015 and 12/2020 in two referral centers in Austria using electronic medical records and national statistical bureau survival data. Patients with recurrent disease, peritoneal carcinomatosis, and emergency surgeries were excluded. Comorbidities were assessed using the CCI, and complication severity was defined by the Clavien-Dindo classification (CDC). Logistic regression analysis was performed to identify factors influencing the risk for postoperative complications, and overall survival was assessed using data from the national statistics bureau.

RESULTS

A total of 471 patients were analyzed. Multinominal logistic regression analysis identified a CCI greater than or equal to 6 ( P =0.049; OR 1.59, 95% CI: 1.10-2.54) and male sex ( P =0.022; OR 1.47, 95% CI: 1.21-2.98) as independent risk factors for major complications. While patients with a high CCI had the worst postoperative survival rates, perioperative complications only impacted on overall survival in patients with low CCIs, but not in patients with high CCIs.

CONCLUSION

Although a high CCI is a risk factor for major postoperative complications, the presence of comorbidities should not result in withholding surgery.

Long-term outcomes in elderly patients after elective surgery for colorectal cancer within an ERAS protocol: a retrospective analysis

PURPOSE

The number of elderly patients with a diagnosis of colorectal cancer (CRC) is increasing. Considering short life expectancy and multiple comorbidities, surgery may not always be the best treatment option.

METHODS

We included all consecutive patients aged 80 years and older who underwent elective resection for CRC following Enhanced Recovery after Surgery (ERAS) protocol between January 2011 and May 2021. The primary endpoint was overall survival, secondary endpoints were 30-day morbidity, and the rate of return to pre-operative living conditions 3 months after surgery.

RESULTS

Ninety-four patients were included. Mean age was 84.6 ± 3.6 years, 49 patients (52%) were female. Most patients (77.6%) were ASA score ≥ 3. Laparoscopic resections were performed in 85 patients (90.4%), involving 69 (73.4%) colonic and 25 (26.6%) rectal resections. A stoma was constructed in 22 patients (23%), and reversed in 12 (54.5%). Twenty-two patients (23.4%) experienced a Clavien-Dindo ≥ 3 complication, and 2 patients (2.1%) died. The median length of hospital stay was 8 (interquartiles: 6-15) days. Sixty-six patients (70.2%) were discharged home directly and 26 (27.7%) to rehabilitation or postacute care institutes. At three months after surgery, eighty-two patients (96.5%) returned to their pre-operative living conditions directly or after short-term rehabilitation. Mean follow-up was 53 ± 33 months, estimated 5-year overall survival was 60.3% (95%CI 49.5-71.1%), and disease-free survival was 86.3% (95%CI 78.1-94.4%).

CONCLUSIONS

Our study suggests that elderly patients undergoing elective surgery have a high potential to return to preoperative living conditions and good overall- and disease-free survivals, despite significant postoperative morbidity.

Laparoscopic versus open surgical management in elderly patients with rectal cancer aged 70 and older

Background

This retrospective study aimed to compare the short- and long-term surgical outcomes of laparoscopic surgery versus open surgery in elderly patients with rectal cancer.

Patients and Methods

Elderly patients (≥70 years old) with rectal cancer who received radical surgery were retrospectively analysed. Patients were matched (1:1 ratio) using propensity score matching (PSM), with age, sex, body mass index, American Society of Anesthesiologists score and tumour-node-metastasis staging included as covariates. Baseline characteristics, post-operative complications, short- and long-term surgical outcomes and overall survival (OS) were compared between the two matched groups.

Results

Sixty-one pairs were selected after PSM. Patients with laparoscopic surgery had a longer duration of operation time, lower estimated blood loss, shorter duration of post-operative analgesics administered, time to first flatus, time to first oral diet and post-operative hospitalisation stay than those observed in patients with open surgery (All P < 0.05). The incidence of post-operative complications in the open surgery group was numerically higher than that occurred in the laparoscopic surgery group (30.6% vs. 17.7%). Median OS was 67.0 months (95% confidence interval [CI], 62.2-71.8) in the laparoscopic surgery group and 65.0 months (95% CI, 59.9-70.1) in the open surgery group, however, Kaplan-Meier curves indicated that no significant differences in OS (Log-rank test, P = 0.535) were noted between the two matched groups.

Conclusions

Compared with the open surgery, laparoscopic surgery had the advantages of less trauma and faster recovery, and provided similar long-term prognostic outcome in elderly patients with rectal cancer.

Comparison of short-term outcomes and survival between minimally invasive colectomy and open colectomy in patients 80 years of age and older

We investigated the short- and long-term outcomes of patients 80 years of age and older with colon cancer who underwent robotic colectomy versus laparoscopic colectomy. Data for patients treated at a comprehensive cancer center between January 2006 and November 2018 were collected retrospectively. Outcomes from minimally invasive laparoscopic or robotic colectomy were compared. Survival was analyzed by the Kaplan-Meier method with significance evaluated by the log-rank test. The laparoscopic (n = 104) and the robotic (n = 75) colectomy groups did not differ across baseline characteristics. Patients who underwent a robotic colectomy had a shorter median length of hospital stay (5 versus 6 days; p < 0.001) and underwent fewer conversions to open surgery (3% versus 17%; p = 0.002) compared to the laparoscopic cohort. The groups did not differ in postoperative complication rates, overall survival or disease-free survival. Elderly patients undergoing robotic colectomy for colon cancer have a shorter hospital stay and lower rates of conversion without compromise to oncologic outcomes.

Robotic surgery in elderly patients with colorectal cancer: Review of the current literature

With an ageing global population, we will see an increasing number of elderly patients with colorectal cancer (CRC) requiring surgery. However, it should be recognized that the elderly are a heterogenous group, with varying physiological and functional status. While traditionally viewed to be associated with frailty, comorbidities, and a higher risk of post operative morbidity, the advancements in minimally invasive surgery (MIS) and improvements in perioperative care have allowed CRC surgery to be safe and feasible in the elderly - chronological age alone should therefore not strictly be an exclusion criterion for curative surgery. However, as a form of MIS, laparoscopic assisted colorectal surgery (LACS) has the inherent disadvantages of: (1) Dependence on a trained assistant for retraction and laparoscope control; (2) The loss of wristed movement with reduced dexterity and suboptimal ergonomics; (3) A lack of intuitive movement due to the levering effect of trocars; and (4) An amplification of physiological tremors. Representing a technical evolution of LACS, robotic assisted colorectal surgery was introduced to overcome these limitations. In this minireview, we examine the evidence for robotic surgery in the elderly with CRC.

Natural Compounds Targeting the Autophagy Pathway in the Treatment of Colorectal Cancer

Autophagy is a highly conserved intracellular degradation pathway by which misfolded proteins or damaged organelles are delivered in a double-membrane vacuolar vesicle and finally degraded by lysosomes. The risk of colorectal cancer (CRC) is high, and there is growing evidence that autophagy plays a critical role in regulating the initiation and metastasis of CRC; however, whether autophagy promotes or suppresses tumor progression is still controversial. Many natural compounds have been reported to exert anticancer effects or enhance current clinical therapies by modulating autophagy. Here, we discuss recent advancements in the molecular mechanisms of autophagy in regulating CRC. We also highlight the research on natural compounds that are particularly promising autophagy modulators for CRC treatment with clinical evidence. Overall, this review illustrates the importance of autophagy in CRC and provides perspectives for these natural autophagy regulators as new therapeutic candidates for CRC drug development.

Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open

The aim of this study was to compare LAP with OPEN regarding short-term mortality, morbidity and completeness of the cancer resection for colon cancer in a routine health care setting using population based register data. All 13,683 patients who were diagnosed 2012-2018 and underwent elective surgery for right-sided or sigmoid colon cancer were included from the Swedish Colorectal Cancer Registry and the National Patient Registry. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, length of hospital stay, reoperation, readmission and positive resection margin (R1). Weighted and unweighted multi regression analyses were performed. There were no difference in 30-day mortality: LAP (0.9%) and OPEN (1.3%) (OR 0.89, 95% CI 0.62-1.29, P = 0.545). The weighted analyses showed an increased 90-day mortality following OPEN, P < 0.001. Re-operations and re-admission were more frequent after OPEN and length of hospital stay was 2.9 days shorter following LAP (P < 0.001). R1 resections were significantly more common in the OPEN group in the unweighted and weighted analysis with P = 0.004 and P < 0.001 respectively. Therefore, the favourable short-term outcomes following elective LAP versus OPEN resection for colon cancer in routine health care indicate an advantage of laparoscopic surgery.

Evaluation of the advantages of robotic versus laparoscopic surgery in elderly patients with colorectal cancer

BACKGROUND

The incidence of colorectal cancer increases with aging. Curative-intent surgery based on a minimally invasive concept is expected to bring survival benefits to elderly patients (aged over 80 years) with colorectal cancer who are frequently with fragile health status and advanced tumors. The study explored survival outcomes in this patient population who received robotic or laparoscopic surgery and aimed to identify an optimal surgical option for those patients.

METHODS

We retrieved the clinical materials and follow-up data on elderly patients with colorectal carcinoma who received robotic or laparoscopic surgery in our institution. The pathological and surgical outcomes were compared to examine the efficacy and safety of the two approaches. The DFS (disease-free survival) and OS (overall survival) results at 3 years after surgery were assessed to explore the survival benefits.

RESULTS

A total of 111 patients were screened for the study, including 55 in the robotic group and 56 in the laparoscopic group. The demographic details were generally similar between the two groups. No statistically significant difference in the number of removed lymph nodes was observed between the two approaches, with a median of 15 versus 14 (P = 0.053). The intraoperative blood loss was significantly reduced by robotic technique when compared to the laparoscopic approach, with a mean of 76.9 ml versus 161.6 ml (P = 0.025). There were no significant differences in operation time, conversion, postoperative complications and recovery, and long-term outcomes between the two groups.

CONCLUSION

Robotic surgery was prized for elderly patients with colorectal cancer who developed anemia and/or hematological conditions.

Effect of comorbidity assessed by the Charlson Comorbidity Index on the length of stay, costs, and mortality among colorectal cancer patients undergoing colorectal surgery

OBJECTIVE

Charlson Comorbidity Index (CCI) is a good predictor for hospitalization cost and mortality among patients with chronic disease. However, the impact of CCI on patients after colorectal cancer surgery is unclear. This study aims to investigate the influence of comorbidity assessed by CCI on length of stay, hospitalization costs, and in-hospital mortality in patients with colorectal cancer (CRC) who underwent surgical resection.

METHODS

This historical cohort study collected 10,271 adult inpatients for CRC undergoing resection surgery in 33 tertiary hospitals between January 2018 and December 2019. All patients were categorized by the CCI score into four classes: 0, 1,2, and ≥3. Linear regression was used for outcome indicators as continuous variables and logical regression for categorical variables. EmpowerStats software and R were used for data analysis.

RESULTS

Of all 10,271 CRC patients, 51.72% had at least one comorbidity. Prevalence of metastatic solid tumor (19.68%, except colorectal cancer) and diabetes without complication (15.01%) were the major comorbidities. The highest average cost of hospitalization (86,761.88 CNY), length of stay (18.13 days), and in-hospital mortality (0.89%) were observed in patients with CCI score ≥3 compared to lower CCI scores (p < .001). Multivariate regression analysis showed that the CCI score was associated with hospitalization costs (β, 7340.46 [95% confidence interval (CI) (5710.06-8970.86)], p < .001), length of stay (β, 1.91[95%CI (1.52-2.30)], p < .001), and in-hospital mortality(odds ratio (OR),16.83[95%CI (2.23-126.88)], p = .0062) after adjusted basic clinical characteristics, especially when CCI score ≥3. Notably, the most specific complication associated with hospitalization costs and length of stay was metastatic solid tumor, while the most notable mortality-specific comorbidity was moderate or severe renal disease.

CONCLUSION

The research work has discovered a strong link between CCI and clinical plus economic outcomes in patients with CRC who underwent surgical resection.

Minimally Invasive Compared to Open Colorectal Cancer Resection for Older Adults: A Population-based Analysis of Long-term Functional Outcomes

OBJECTIVE

We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection.

BACKGROUND

Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown.

METHODS

We performed a population-based analysis of patients ≥70years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and "high" time-at-home, which we defined as years with ≤14 institution-days, in the 5years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High timeat-home was assessed using Cox multivariable models.

RESULTS

Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1-7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87,95% confidence interval (CI) 0.83-0.92]. The MIS group had higher probability ofhigh time-at-home than open surgery with 54.9% (95% CI 53.6%-56.1%) versus 41.2% (95% CI 40.1%-42.3%) at 5years (hazard ratio 0.71, 95% CI 0.68-0.75).

CONCLUSIONS

Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.

Risk of non-colorectal cancer-related death in elderly patients with the disease: A comparison of five preoperative risk assessment indices

BACKGROUND

A considerable number of elderly patients with colorectal cancer (CRC) die of non-CRC-related causes. The Controlling Nutritional Status (CONUT) score, American Society of Anesthesiologists Physical Status classification, Charlson Comorbidity Index, National Institute on Aging, and National Cancer Institute Comorbidity Index, and Adult Comorbidity Evaluation-27 score are all known predictors of survival in patients with CRC. However, the utility of these indices for predicting non-CRC-related death in elderly CRC patients is not known.

METHODS

The study population comprised 364 patients aged 80 years or more who received curative resection for stage I-III CRC between 2000 and 2016. The association of each index with non-CRC-related death was compared by competing-risks analysis such as the cumulative incidence function and proportional subdistribution hazards regression analysis as well as time-dependent receiver-operating characteristic (ROC) analysis.

RESULTS

There were 85 deaths (40 CRC-related and 45 non-CRC-related) during a median observation period of 53.2 months. Cumulative incidence function analysis identified CONUT score as the most suitable for risk stratification for non-CRC-related death. In proportional subdistribution hazards regression, risk of non-CRC-related death increased significantly as CONUT score worsened (2/3/4 vs. 0/1, hazard ratio 1.73, 95% confidence interval [CI] 0.91-3.15; ≥5 vs. 2/3/4, hazard ratio 2.71, 95% CI 1.08-6.81). Time-dependent ROC curve analysis showed that CONUT score were consistently superior to other indices during the 5-year observation period.

CONCLUSIONS

The majority of deaths in elderly patients with CRC were not CRC-related. CONUT score was the most useful predictor of non-CRC-related death in these patients.

Preoperative plasma vitamin D in patients with localized colorectal cancer: Age-dependent association with inflammation, postoperative complications, and survival

INTRODUCTION

Aging is often associated with low-grade chronic inflammation and a senescent immune system. Vitamin D is a regulator of immune function, and low plasma vitamin D is associated with poor health. The association between plasma vitamin D and inflammatory biomarkers and risk of postoperative complications and survival in patients with colorectal cancer (CRC) is unknown. Our aim was to investigate these associations and how they are influenced by age.

MATERIALS AND METHODS

Circulating vitamin D and the inflammatory biomarkers C-reactive protein (CRP), interleukin (IL)-6, and YKL-40 were measured in 398 patients with stage I-III CRC preoperatively. Older patients (≥70 years, n = 208) were compared to younger patients (<70 years, n = 190). The relation between vitamin D and complications and high inflammatory biomarker levels was presented by odds ratios ([OR], 95% confidence interval [CI]). Associations with survival were presented with hazard ratios ([HR], 95% CI).

RESULTS

Plasma vitamin D was higher in older patients than in younger patients (75 vs. 67 nmol/L, P = 0.001). High vitamin D was associated with low plasma CRP in younger patients (OR = 0.35, 95% CI 0.17-0.76), but not in older patients (OR = 0.93, 0.49-1.76). High vitamin D in older patients with CRC was associated with reduced risk of major complications (OR = 0.52, 0.28-0.95). This was not found in younger patients (OR = 1.47, 0.70-3.11). Deficient vitamin D (<25 nmol/L) was associated with short overall survival compared to sufficient (>50 nmol/L) irrespective of age (HR = 3.39, 1.27-9.37, P = 0.02).

CONCLUSION

For patients with localized CRC, high vitamin D levels before resection were associated with reduced risk of high inflammatory biomarkers for younger patients and reduced risk of major postoperative complications for older patients. Vitamin D deficiency was associated with reduced survival regardless of age.

Laparoscopic versus open surgery for elderly patients with colorectal cancer: a systematic review and meta-analysis of matched studies

BACKGROUND

To compare clinical and survival outcomes between laparoscopic versus open surgery in elderly colorectal cancer patients.

METHODS

PubMed, Embase and Scopus databases were systematically searched. The review included studies that were either randomized controlled trials (RCTs) or observational in design. STATA was used for statistical analysis.

RESULTS

The meta-analysis was conducted with 24 studies. Compared with elderly subjects with open surgery, those undergoing laparoscopic surgery had a lower risk of mortality (within 3 months postoperatively) (RR 0.70, 95% CI: 0.53, 0.94). The long-term overall survival (HR 0.96, 95% CI: 0.89, 1.04), disease-free survival (HR 1.02, 95% CI: 0.93, 1.13), risk of recurrence (RR 1.44, 95% CI: 0.90, 2.30) and readmission (RR 1.11, 95% CI: 0.88, 1.40) rates were statistically similar in both the groups. The operative time (in minutes) was higher (WMD 30.37, 95% CI: 17.75, 43.0) and the blood loss (in ml) was lower (WMD -78.85, 95% CI: -101.96, -55.75) in those undergoing laparoscopic surgery. The length of hospital stay (in days) (WMD -2.53, 95% CI: -3.11, -1.95) and the time of return of bowel movements (in days) (WMD -1.06, 95% CI: -1.20, -0.93) was lower in those with laparoscopic surgery. The pooled risk of complications was lower in those with laparoscopic surgery (RR 0.66, 95% CI: 0.60, 0.74), compared with open surgery.

CONCLUSIONS

Findings suggest that in elderly subjects with colorectal cancer, laparoscopic surgery appears to be more beneficial than open surgery and should be prioritized, subject to the availability of required technical skills and facilities.

Application Effect of Robot-Assisted Laparoscopy in Hepatectomy for Colorectal Cancer Patients with Liver Metastases

Objective

Application effect of Leonardo's robot-assisted laparoscopy in hepatectomy for colorectal cancer patients with liver metastases.

Methods

A total of 122 patients with sCRLM treated in our hospital from May 2015 to June 2018 were selected and divided into observation group (n = 61) and control group (n = 61) according to random number table method. The observation group was treated with robot-assisted laparoscopic hepatectomy, while the control group was treated with conventional laparoscopic hepatectomy. The perioperative time, intraoperative blood transfusion, intraoperative blood loss, average intraoperative blood transfusion, and hepatic portal occlusion time of the two groups were observed. Serum cortisol (Cor), norepinephrine (NE), and glucose (Glu) levels were detected before and after surgery in the two groups. The oxygen consumption and carbon dioxide output of patients were measured 1 day before surgery and 1~3 days after surgery, and the resting energy expenditure (REE) value was calculated. The levels of CD3+, CD4+, and CD8+ were determined by flow cytometry. The incidence of complications was compared between the two groups. Patients were followed up for 3 years after discharge, and Kaplan-Meier method was used to analyze the survival of the two groups.

Results

The operation time, intraoperative blood transfusion, intraoperative blood loss, and average intraoperative blood transfusion in the observation group were all less than those in the control group, and the differences were statistically significant (P < 0.05). Three days after operation, the levels of serum Cor, NE, and Glu were increased in both groups, and the observation group was lower than the control group; the difference was statistically significant (P < 0.05). The REE level of observation group was lower than that of control group after 1 day, 2 days, and 3 days after surgery, and the difference was statistically significant (P < 0.05). Three days after operation, the levels of serum CD3+ and CD4+ were decreased in both groups, and the observation group was higher than the control group; the difference was statistically significant (P < 0.05). The incidence of complications in the observation group (3.28%) was lower than that in the control group (13.11%); the difference was statistically significant (P < 0.05).There was no significant difference in survival rate between the two groups after 1, 2, and 3 years of follow-up (P > 0.05).

Conclusion

The application of robot-assisted laparoscopy in patients with sCRLM can effectively improve the perioperative situation of patients, reduce stress, energy metabolism, and immune damage, and reduce the incidence of complications.

Assessment of the Use of Preoperative CT Scan Image for Predicting Lymph Nodes for Resection of Colorectal Cancer: A Retrospective Study

<b><i>Introduction:</i></b> Colorectal cancer (CRC) is the most common cancer that accounts for nearly 10% of the cancers, with 1.36 million people worldwide. Nodal status (N-stage) evaluation was inferior between observers, which considered CT scanning a good N-stage. We hypothesized that CRC patients’ preoperative CT scan imaging predicts the nodal and metastatic stage. <b><i>Methods:</i></b> This noninterventional retrospective study was carried out using patients’ medical records, including medical history and results of diagnostic tests, and preoperative clinical and pathological stages. All direct identifiers have been removed from all patient data. This study included 96 patients who underwent resection curative surgery for CRC at the Tertiary Hospital, Sudan, between March 2009 and December 2020. <b><i>Results:</i></b> The median age was 69 years (47–74 years), and 49 (51.04%) were female. The tumor stage of the patients was 4, 11, 74, and 7 as T1, T2, T3, and T4, respectively. A total of 38 patients with a malignant spread in lymph nodes were observed, and the median lymph node count was 11 (range 4–52). Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), and accuracy calculated for the malignant lymph nodes were 75.56% (95% CI: 60.46–87.12%), 45.10% (95% CI: 31.13–59.66%), 1.38 (95% CI: 1.02–1.86), 0.54 (95% CI: 0.30–0.98), 54.84% (95% CI: 47.38–62.09%), 67.65% (95% CI: 53.53–79.15%), and 59.38% (95% CI: 48.87–69.29%), respectively. <b><i>Conclusion:</i></b> The preoperative CT scan images were used to predict lymph nodes with a diagnostic accuracy of 59.38% for N-stage in patients with CRC.

Influence of Early Predictive Nursing on Complications and Quality of Life in Patients after Colorectal Cancer Surgery

Objective

To analyze the effect of early predictive nursing on complications and quality of life in patients after colorectal cancer surgery.

Methods

A total of 130 patients with colorectal cancer who were diagnosed and underwent surgical resection in our hospital from 2019 to 2021 were recruited and assigned via the random number table method (1 : 1) to receive either conventional nursing (routine group) or predictive nursing (study group). Outcome measures included the incidence of complications and the quality of life.

Results

Predictive nursing was associated with shorter operation time and hospital stay and less blood loss (2.35 ± 0.41, 9.32 ± 1.86, and 70.52 ± 16.52) versus conventional nursing (3.02 ± 0.78, 11.20 ± 2.14, and 81.51 ± 17.74) (all P < 0.05). Patients in the study group showed a lower incidence of complications than the control group (10.76% vs 35.38%) (all P < 0.05). Predictive nursing resulted in better anxiety relief than conventional nursing (P < 0.05). Predictive nursing was associated with higher emotional function, cognitive function, role function, and physical function scores (83.51 ± 12.56, 82.45 ± 9.15, 82.48 ± 10.46, 84.43 ± 13.48, and 82.73 ± 9.67) than conventional nursing (73.85 ± 13.54, 72.54 ± 12.74, 72.48 ± 10.45, 73.99 ± 14.51, and 72.45 ± 11.69) (all P < 0.05). Patients receiving predictive nursing showed a significantly higher nursing satisfaction versus conventional nursing (P < 0.05).

Conclusion

Early predictive nursing for patients receiving colorectal cancer surgery can lower the incidence of complications, effectively improve the quality of life of patients, shorten the hospital stay, reduce the amount of bleeding, and enhance the satisfaction of patients.

Comparison of clinical efficacy and postoperative inflammatory response between laparoscopic and open radical resection of colorectal cancer

BACKGROUND

In recent years, the incidence of colorectal cancer (CRC) has increased annually, which has seriously threatened the health and quality of life of patients. In the treatment of CRC, both laparoscopic and radical resection are widely used.

AIM

To explore and discuss clinical efficacy and postoperative inflammatory response of laparoscopic and open radical resection of CRC.

METHODS

A total of 96 patients with CRC diagnosed in our hospital from March 2016 to April 2021 were selected, and were divided into the study group (n = 48) and control group (n = 48) using a simple random method. The control group was treated with open radical resection of CRC, and the study group was treated with laparoscopic radical resection of CRC. The perioperative conditions (operation time, intraoperative blood loss, the recovery time of gastrointestinal function, number of lymph node dissections and length of hospital stay), inflammatory response index levels [interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP)] before and after operation, pain stress response indices [levels of neuropeptide (NPY), prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT)], and the incidence of the complications between the two groups were counted.

RESULTS

The operation time in the study group was (186.18 ± 33.54 min), which was longer than that of the control group (129.38 ± 26.83 min), but the intraoperative blood loss (111.34 ± 21.45 mL), recovery time of gastrointestinal function (25.35 ± 4.55 h), and hospital stay (10.09 ± 2.38 d) were better than those in the control group (163.77 ± 32.41 mL, 36.06 ± 7.13 h, 13.51 ± 3.66 d) (P < 0.05). There was no significant difference in the number of lymph node dissections between the study group (15.19 ± 3.04) and the control group (16.20 ± 2.98) (P > 0.05). There was no significant difference between the levels of serum IL-6 (9.79 ± 4.11 ng/mL), IL-8 (3.79 ± 1.71 ng/L), IL-10 (48.96 ± 12.51 ng/L) and CRP (7.98 ± 2.33 mg/L) in the study group and the control group (10.56 ± 3.78 ng/mL, 4.08 ± 1.45 ng/L, 50.13 ± 11.67 ng/L, 8.29 ± 2.60 mg/L) before the operation (P > 0.05). After the operation, there was no significant difference between the levels of serum IL-6 (19.11 ± 6.68 ng/mL). There was no significant difference in serum NPY (109.79 ± 13.46 UG/L), PGE2 (269.54 ± 37.34 ng/L), 5-HT (151.70 ± 18.86 ng/L) between the study group and the control group (113.29 ± 15.01 UG/L, 273.91 ± 40.04 ng/L, 148.85 ± 20.45 ng/L) before the operation (P > 0.05). The incidence of the complications in the study group (4.17%) was lower than that of the control group (18.75%) (P < 0.05).

CONCLUSION

Laparoscopic radical resection of CRC can reduce surgical trauma, inflammatory response and pain stress caused by surgery, which shortens rehabilitation of patients, with a low incidence of complications.

Comparison of surgical and oncologic outcomes in very elderly patients (≥ 80 years old) and elderly (65-79 years old) colorectal cancer patients: a propensity score matching

Purpose

The purpose of this study was to investigate the short-term outcomes and prognosis of elderly and very elderly colorectal cancer (CRC) patients after primary CRC surgery using propensity score matching (PSM).

Methods

This study retrospectively collected the medical records of CRC patients ≥ 65 years old undergoing primary CRC surgery from Jan 2011 to Jan 2020. Short-term outcomes, overall survival (OS) and disease-free survival (DFS) were compared between very elderly CRC patients (≥ 80 years old) and elderly CRC patients (65–79 years old).

Results

A total of 2084 patients were enrolled for analysis. After PSM, 331 very elderly patients were matched to 331 elderly patients. In terms of short-term outcomes, the very elderly patients had longer postoperative hospital stays (p = 0.007) after PSM. In terms of OS, it was found that age (p < 0.01, HR = 1.878, 95% CI 1.488–2.371), tumor stage (p < 0.01, HR = 1.865, 95% CI 1.603–2.170), overall complications (p < 0.01, HR = 1.514, 95% CI 1.224–1.872) and major complications (p = 0.001, HR = 2.012, 95% CI 1.319–3.069) were independent prognostic factors. For DFS, age (p < 0.01, HR = 1.816, 95% CI 1.579–2.088), tumor stage (p < 0.01, HR = 1.816, 95% CI 1.579–2.088), overall complications (p = 0.002, HR = 1.379, 95% CI 1.128–1.685) and major complications (p = 0.002, HR = 1.902, 95% CI 1.259–2.874) were found to be independent prognostic factors. Moreover, elderly patients had a better OS and DFS than very elderly patients.

Conclusion

Very elderly patients had a poorer prognosis than elderly patients after primary CRC surgery. Surgeons should be cautious when treating very elderly CRC patients.

Robot-Assisted vs Laparoscopic Right Hemicolectomy in Octogenarians

OBJECTIVE

With increasing age, there is greater need for right-sided colonic resections than its left-sided counterparts. Older age is associated with limited physical and functional status, which carries greater operative risk. Improvements in robotic surgery questions its role, especially in older adults, compared with laparoscopy. The objective is to investigate whether robotic right hemicolectomy (RRH) is as safe and effective as laparoscopic right hemicolectomy (LHR) in octogenarians (age >80 years).

DESIGN

Retrospective cross-sectional analysis.

SETTINGS AND PARTICIPANTS

Octogenarians who underwent elective RRH and LRH by the Tweed Colorectal Group over 5 years.

METHODS

Complications within 30 days, age, gender, smoking status, immunocompromised status, presence of diabetes, American Society of Anesthesiologists (ASA) physical status score, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, mFI-5 (modified frailty index), operative time, method of anastomosis, postoperative length of stay (LOS), need for rehabilitation, and short-term oncologic data using the TNM criteria were compared using univariate and multivariate analysis.

RESULTS

Seventy-eight elective patients were included. LRH and RRH groups had similar median ages, gender distribution, and comorbidities. Across the entire cohort, 61.5% had no 30-day complications. RRH had nonsignificantly shorter operative time but significantly shorter LOS (5 vs 8 days) and fewer minor complications (24.5% vs 34.5%). Major complications and overall complications were not significantly different between the groups. Lower ASA and ECOG status were associated with lower complication rates across both groups. Oncologic resection outcomes were similar for both approaches.

CONCLUSIONS AND IMPLICATIONS

RRH does not confer an increased risk of complications compared to LRH in the octogenarians and may be a viable alternative in the field of minimally invasive surgery for older patients. Future research should focus on intracorporeal anastomoses, as it is a potential confounder leading to the shorter inpatient LOS shown in our robotic group.

Laparoscopic Radical Resection of Colorectal Cancer in the Treatment of Elderly Colorectal Cancer and Its Effect on Gastrointestinal Function

Objective

To explore the efficacy and safety of laparoscopic radical resection of colorectal cancer in the elderly patients and its impact on gastrointestinal function.

Methods

A total of 122 elderly patients with colorectal cancer admitted to our hospital from March 2020 to June 2021 were selected as the research subjects, and they were divided into the control group (n = 61) and the observation group (n = 61). The control group was treated with traditional laparotomy, and the observation group was treated with laparoscopic radical resection of colorectal cancer. The clinical data of operation time, incision length, intraoperative bleeding volume, and hospitalization time in the two groups were recorded. Serum motilin (MTL) and gastrin (GAS) levels were measured pre- and post-operatively. The duration of abdominal distension, the time for the abdominal sound to return to normal, the time for the anal exhaust to normal, and the time for normal food intake were recorded after operation. The patients were followed up for 6 months post-operatively, and the complications during follow-up were recorded.

Results

The total response rate of the observation group (95.08%) was higher than that of the control group (81.97%) (P < 0.05). The operation time, incision length, intraoperative bleeding volume, and hospitalization time of the observation group were lower than those of the control group (P < 0.05). The duration of abdominal distension, the time for bowel sounds to return to normal, the time for the anus to exhaust gas to normal, and the normal eating time in the observation group were all lower than those in the control group (P < 0.05). After surgery, the levels of MTL and GAS in the two groups were lower than those before surgery, and those in the observation group were lower than those in the control group (P < 0.05). The total incidence of complications in the observation group (3.28%) was lower than that in the control group (13.12%) (P < 0.05).

Conclusion

Laparoscopic radical resection of colorectal cancer in the elderly patients has good effect, short operation time, less trauma, less blood loss during operation, short hospital stay, good recovery of gastrointestinal function, fewer complications, and high safety.

Colorectal cancer surgery in elderly patients 80 years and older: a comparison with younger age groups

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.

Operative and Survival Outcomes of Robotic-Assisted Surgery for Colorectal Cancer in Elderly and Very Elderly Patients: A Study in a Tertiary Hospital in South Korea

Materials and Methods

Data of all patients ≥75 years who underwent a robotic-assisted curative resection in Korea University Anam Hospital, Seoul, South Korea, between January 2007 and January 2021 were extracted from a prospectively maintained colorectal cancer database. Patients were subdivided into the three groups according to the age: youngest-old (YO: 75–80 years), middle-old (MO: 81–85), and oldest-old (OO: ≥86 years). Intraoperative findings, postoperative, and oncological outcomes were compared between the groups.

Results

Seventy-six consecutive patients (female 52.6%) were included; mean age was 80 years (SD 0.33); mean body mass index (BMI), 23.8 20.9 kg/m² (SD 3.58); mean total operative time, 279 min (SD 80.93); mean blood loss, 186 ml (SD 204.03); mean postoperative length of stay, 14 days (SD 12.03). Major complications were seen in 2.1% of patients. The 30-day mortality rate was 0%. Average number of lymph node harvested was 20.9 (SD 12.33). Postoperative complications were not statistically different between the groups. Mean follow-up time for cancer-specific survival (CSS) was 99.28 months for the YO, 72.11 months for MO, and 31.25 months for OO groups (p = 0.045). The CSS rates at 5 years were 27.0%, 21.0%, and 0%, respectively. Recurrence risk was 10.50 times higher in the OO group than the others (adjusted HR, 95% CI 1.868–59.047, p = 0.008). In the multivariable analysis, TNM stage was not a risk factor for CSS in all groups. The number of the harvested nodes was a protective factor for recurrence (HR of 0.932, 95% CI 0.875–0.992, p = 0.027) and CSS (HR of 0.928, 95% CI 0.861–0.999, p = 0.047) in elderly patients.

Conclusion

Robotic surgery is highly feasible in elderly and very elderly colorectal cancer patients, providing a favorable operative safety profile and an acceptable cancer-specific survival outcome.

Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center

BACKGROUND

As a common gastrointestinal malignancy, colorectal cancer (CRC) poses a serious health threat globally. Robotic surgery is one of the future trends in surgical treatment of CRC. Robotic surgery has several technical advantages over laparoscopic surgery, including 3D visualization, elimination of the fulcrum effect, and better ergonomic positioning, which together lead to better surgical outcomes and faster recovery. However, analysis of independent factors of postoperative complications after robotic surgery is still insufficient.

AIM

To analyze the incidence and risk factors for postoperative complications after robotic surgery in patients with CRC.

METHODS

In total, 1040 patients who had undergone robotic surgical resection for CRC between May 2015 and May 2020 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo (C-D) classification, and possible risk factors were evaluated.

RESULTS

Among 1040 patients who had undergone robotic surgery for CRC, the overall, severe, local, and systemic complication rates were 12.2%, 2.4%, 8.8%, and 3.5%, respectively. Multivariate analysis revealed that multiple organ resection (P < 0.001) and level III American Society of Anesthesiologists (ASA) score (P = 0.006) were independent risk factors for overall complications. Multivariate analysis identified multiple organ resection (P < 0.001) and comorbidities (P = 0.029) as independent risk factors for severe complications (C-D grade III or higher). Regarding local complications, multiple organ resection (P = 0.002) and multiple bowel resection (P = 0.027) were independent risk factors. Multiple organ resection (P < 0.001) and level III ASA score (P = 0.007) were independent risk factors for systemic complications. Additionally, sigmoid colectomy had a lower incidence of overall complications (6.4%; P = 0.006) and local complications (4.7%; P = 0.028) than other types of colorectal surgery.

CONCLUSION

Multiple organ resection, level III ASA score, comorbidities, and multiple bowel resection were risk factors for postoperative complications, with multiple organ resection being the most likely.

The relationship between TESTIN expression and the prognosis of colorectal cancer

BACKGROUND

Colorectal carcinoma (CRC) represents a most grave healthy burden worldwide. TESTIN has been confirmed as a predictive biomarker for several cancers. In the present study, we sought to assess the expression level and prognostic values of TESTIN in CRC.

METHODS

The levels of TESTIN mRNA and protein were detected in 132 paired CRC tissues and noncancerous ones via quantitative real-time polymerase chain reaction (qRT-PCR) and immunohistochemistry (IHC) assays, respectively. Chi-square test was adopted to analyze the association of TESTIN expression with clinicopathological profiles of CRC patients. To explore prognostic value of TESTIN, Kaplan-Meier curve and Cox regression analyses were employed.

RESULTS

TESTIN expression was down-regulated among CRC tissues in comparison to bordering cancer-free samples at both protein and mRNA levels (P < 0.001). Decreased TESTIN expression was closely related to poor tumor differentiation (P = 0.001) and advanced TNM stages (P = 0.001). CRC cases with low expression of TESTIN were more likely to undergo dismal overall survivals (log-rank P = 0.003). Multivariate Cox analysis unveiled that down-regulated expression of TESTIN was independently correlated with poor prognosis (HR=2.422, 95% CI=1.294-4.535, P = 0.006).

CONCLUSION

The down-regulation of TESTIN may predict dismal prognosis for CRC patients.

Factors affecting short-term survival in patients older than 85 treated with resection for stage II and III colon cancer

BACKGROUND

Patients ≥85 years of age have high rates of colon cancer but disproportionately poor outcomes. Factors affecting short-term (90-day) survival in patients ≥85 undergoing surgery for stage II and III colon cancer were examined to identify potentially modifiable factors to improve outcomes.

METHODS

The New York State Cancer Registry and Statewide Planning Research and Cooperative System were queried for patients ≥85 years who underwent colectomy for stage II and III colon cancer between 2004 and 2012. Regression analyses were performed for factors associated with 90-day mortality and stratified by elective and nonelective surgery.

RESULTS

In total, 3,779 patients ≥85 years of age underwent colectomy between 2004 and 2012 for stage II or III colon cancer. Of these, 48.4% underwent nonelective colectomy, 79.9% had an open operation, and 90-day survival was 83.2%. Worse survival was associated with nonelective surgery (odds ratio = 3.81, 95% confidence interval = 3.03-4.89). Improved survival in the nonelective and overall groups was associated with a minimally invasive operation (nonelective group: odds ratio = 0.35, 95% confidence interval = 0.21-0.58; overall group: odds ratio = 0.50, 95% confidence interval = 0.36-0.73) and discharged to another health care facility (nonelective group: odds ratio = 0.30, 95% confidence interval = 0.22-0.39; overall group: odds ratio = 0.42, 95% confidence interval = 0.33-0.53). High surgeon annual operating volume was associated with improved survival in the elective and nonelective groups (P < .001).

CONCLUSION

Factors associated with greater odds of 90-day mortality in this population include nonelective surgery, preoperative weight loss, and multiple comorbidities, whereas a minimally invasive approach was associated with lower mortality. Potential areas to improve outcomes in this population include using a multidisciplinary team approach, addressing frailty preoperatively when possible, and potentially reconsidering screening guidelines for colorectal cancer to reduce rates of emergency operations.

Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients

OBJECTIVES

To evaluate future problems in colorectal cancer surgery for elderly patients.

METHODS

We conducted a retrospective review of patients receiving colorectal cancer surgery in our hospital from January 2010 to December 2018. Patients were divided into the ≥ 85-year-old patient group and the younger patient group. We compared patient backgrounds, surgical outcomes (surgical procedure, reduction of lymph node dissection range, operative duration, and blood loss), postoperative short-term outcomes (mortality, morbidity, and postoperative length of stay) and prognosis.

RESULTS

We performed colorectal cancer surgery on 1,240 patients during the study period. Of them, 109 (8.7%) were ≥ 85 years old, and 1,131 (91.2%) were < 85 years old. The American Society of Anesthesiologists physical status (ASA-PS) was significantly poorer in the elderly group than in the younger group and patients with a history of cardiac disease and anticoagulant use were significantly more in the elderly group. The rate of reduction of lymph node dissection range was significantly higher in the elderly group (16.8% vs. 3.8%, p < 0.05). Overall morbidity was significantly higher in the elderly group (42.2% vs. 21.9%, p < 0.05), as were the respective frequencies of pneumonia and thromboembolism (8.2% vs. 0.7%, p < 0.05 and 3.6% vs. 0.8%, p < 0.05, respectively). Postoperative hospital stay was significantly longer in the elderly group (17 vs. 12 days, p < 0.05). Overall survival was significantly lower in the elderly group (p < 0.05), but relapse-free survival and colorectal cancer-specific survival were not statistically different between the groups (p = 0.05 and p = 0.15, respectively).

CONCLUSIONS

Prevention of postoperative pneumonia and thromboembolism remains a problem. After proper assessment and careful management of peri-operative surgical risks, surgery can be indicated in elderly patients.