Colorectal cancer outcomes in nonagenarian patients: A case series

Au, Shannon Wing Ngor; Ventham, Nicholas T.; Yalamarthi, Satheesh; Manimaran, N

doi:10.1016/j.ijsu.2018.05.032

Cited by 11 publications

(20 citation statements)

References 25 publications

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“…Elective surgery mortality was 4.2%. These results are in accordance with other authors [8,10,12,22], who have reported mortality rates oscillating between 2.1% [8] and 23% [9].…”

Section: Discussionsupporting

confidence: 93%

“…In the present study, the procedure most frequently performed was right colectomy followed by the Hartmann procedure, which was in line with other series [8,11,22]. Available studies suggest that tumors are more likely to be right-sided in nonagenarian patients [2,10].…”

Section: Discussionsupporting

confidence: 90%

“…The most frequent complication in the present study was postoperative ileus, which is quite frequent in this age group. In other series, postoperative confusion prevails [22], which is often difficult to assess and whose actual frequency of presentation can be masked in the surgical setting. Respiratory complications, renal failure, and surgical site infection have also been reported as frequent complications in nonagenarians [11].…”

Section: Discussionmentioning

confidence: 99%

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Colorectal cancer surgery in selected nonagenarians is relatively safe and it is associated with a good long-term survival: an observational study

et al. 2020

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Background: Advanced age is a risk factor for colorectal cancer, and very elderly patients often need to be surgically treated. This study aimed to analyze the outcomes of a cohort of nonagenarian patients operated on for colorectal cancer. Methods: Observational study conducted on a cohort of 40 nonagenarian patients, who were treated surgically for colorectal cancer between 2000 and 2018 in our institution. Clinical data, ASA score, Charlson Comorbidity Index, Surgical Mortality Probability Model, tumor characteristics, and nature and technical features of the surgical procedure, were recorded. The Comprehensive Complication Index (CCI) and survival time after the procedure were recorded as outcome variables. Univariate and multivariate analyses were performed in order to define risk factors for postoperative complications and long-term survival. Results: Out of the 40 patients, 13 (32.5%) were men, 27 (67.5%) women, and mean age 91.6 years (SD ± 1.5). In 24 patients (60%), surgery was elective, and in 16 patients (40%), surgery was emergent. Curative surgery with intestinal resection was performed in 34 patients (85%). In 22 patients (55%), intestinal continuity was restored by performing an anastomosis. The median CCI was 22.6 (IRQ 0.0-42.6). Operative mortality was 10% (4 patients). Cumulative survival at 1, 3, and 5 years was 70%, 47%, and 29%, respectively. In multivariate analysis, only the need for transfusion remained as an independent prognostic factor for complications (p = 0.021) and TNM tumor stage as a significant predictor of survival (HR 3.0, CI95% 1.3-7.2). Conclusions: Colorectal cancer surgery is relatively safe in selected nonagenarian patients and may achieve longterm survival.

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“…Elective surgery mortality was 4.2%. These results are in accordance with other authors [8,10,12,22], who have reported mortality rates oscillating between 2.1% [8] and 23% [9].…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Colorectal cancer surgery in selected nonagenarians is relatively safe and it is associated with a good long-term survival: an observational study

et al. 2020

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“…Nevertheless, the finding that surgery is feasible and has potential prognostic advantage is important. Overall and in line with previous reports, patients requiring urgent surgery had bad outcomes, whereas age alone was not associated with increased postoperative complications …”

Section: Discussionsupporting

confidence: 90%

Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit

Shafrir

Koslowsky

Wengrower

et al. 2019

J American Geriatrics Society

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OBJECTIVES Data regarding colonoscopy in patients older than 90 years old is scarce. Yet the number of colonoscopies done on nonagenarians is rising. We aimed to determine the yield, safety, and therapeutic benefits of colonoscopy in these patients. DESIGN Case‐control study of older patients who underwent colonoscopy. SETTING Gastroenterology institute at an academic medical center. PARTICIPANTS Patients older than 90 years (n = 128) compared with patients aged 80 to 89 years (n = 218) who underwent colonoscopy. INTERVENTION Colonoscopy. MEASUREMENTS Indication for the procedure, completion rates, adequacy of preparation, complications, colonoscopic findings, 30‐day mortality, advanced adenoma and carcinoma detection rate, treatment, and long‐term survival of patients diagnosed with colorectal cancer. RESULTS Mean ages were 83.3 and 92.2 years old. Nonagenarians were more likely to undergo a colonoscopy while hospitalized (56.2 vs 23.4%; P < .001) and to undergo the examination due to rectal bleeding or sigmoid volvulus (35.2 vs 25.2 and 10.9 vs 0.5%, respectively; P < .001) and less likely for surveillance or constipation (11.7 vs 25.7 and 0 vs 6.9%, respectively; P < .001). Completion rates and severe adverse events were comparable. The 30‐day mortality was 3.9% in nonagenarians and 0.4% in octogenarians (P = .02). Advanced adenomas and carcinoma were more common in nonagenarians (25.8 vs 16.5%, P = .03, and 14.8 vs 6.4%, P = .01, respectively). Increasing age, inpatient status, past polypectomy surveillance, and anemia were associated with higher rates of carcinoma. Half of the nonagenarians diagnosed with adenocarcinoma underwent surgery compared with 100% of octogenarians (P = .01). Among nonagenarians with colorectal cancer who died, mean survival was 605 (interquartile range = 11‐878) days in those who underwent surgery and 112 (48‐341) in those treated conservatively (P = .055 log‐rank test). CONCLUSION Colonoscopy in nonagenarians has a high yield and is generally safe. Colonoscopy findings lead to surgery in more than half of these patients and was associated with a median survival of 20 months.

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“…In conclusion, the improved surgical techniques and the advancements in anesthesiology made this surgery feasible for the majority of older patients, with no definitive consensus about which is the optimal surgical management for older people admitted to the emergency department with diagnosis of complicated CRC. Similarly, a paucity of studies evaluated early and late outcomes in cohort of patients aged over 90 [3,32,33]. To the best of our knowledge, this is the first report of a successful surgery with curative intent for ascending colon cancer in a centenarian with a postoperative follow-up of nine months.…”

Section: Discussionmentioning

confidence: 94%

A two-step surgery and a multidisciplinary approach in a centenarian patient with an acute presentation of right colon cancer

et al. 2020

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Background: As surgery remains the cornerstone of colorectal cancer (CRC) treatment, the number of older patients presented for colorectal resection is rapidly increasing. Nevertheless, the choice to operate an oldest-old patient still remain challenging and requires a careful assessment of risk to benefit ratio in order to guarantee appropriate surgical strategies and perioperative management. Case presentation: A centenarian patient, acutely admitted to the emergency department, was diagnosed with an ileus caused by stenosing ascending colon cancer with abnormal distension of the right colon at high risk of perforation. Facing with this complex clinical scenario, a lateral decompressive cecostomy as alternative surgical procedure, was performed in local anesthesia in order to avoid the stressful event of an emergency surgery. Thereafter, the patient was admitted to the surgical ward and followed by a geriatrician who performed a comprehensive geriatric assessment (CGA) and daily clinical evaluations. This integrated plan of care was mainly focused on rehabilitation, nutritional interventions and therapeutic reconciliation, maximizing patient's clinical conditions and performance status. Then, the second surgical step, the radical colon surgery with curative intent and bowel continuity reestablishment was performed, demonstrating to be feasible and safety also in a very advanced age patient in term of prolonged survival and preservation of an adequate quality of life. Conclusions: This is the first case-report that illustrates a successful two step surgery for CRC in a centenarian patient thanks to a multidisciplinary based approach, overwhelming the mere concept of chronological age.

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Colorectal cancer outcomes in nonagenarian patients: A case series

Cited by 11 publications

References 25 publications

Colorectal cancer surgery in selected nonagenarians is relatively safe and it is associated with a good long-term survival: an observational study

Colorectal cancer surgery in selected nonagenarians is relatively safe and it is associated with a good long-term survival: an observational study

Colonoscopy in Nonagenarians Is Safe and May Be Associated with Clinical Benefit

A two-step surgery and a multidisciplinary approach in a centenarian patient with an acute presentation of right colon cancer

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