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

Weerink, Linda B M; Gant, Christina M.; Leeuwen, Barbara L. van; Bock, Geertruida H. de; Kouwenhoven, Ewout A.; Faneyte, Ian F.

doi:10.1245/s10434-018-6766-1

Cited by 49 publications

(44 citation statements)

References 47 publications

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“…Long-term survival and recurrent disease depend on the stage of tumour [30]. Stage III disease is associated with diminished survival [4,30,34] [35,36]. However, the real rate of recurrences in our series may have been higher, as further investigations and treatment may have been stopped by an unwilling patient or by a physician who considered a patient too frail or unfit.…”

Section: Discussionmentioning

confidence: 75%

Long‐term survival following elective colon cancer surgery in the aged. A population‐based cohort study

et al. 2020

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Aim The number of colorectal cancer patients increases with age. Long-term data support personalized management due to heterogeneity within the older population. This registry-and population-based study aimed to analyse long-term survival, and causes of death, after elective colon cancer surgery in the aged, focusing on patients who survived more than 3 months postoperatively. Methods The data included patients ≥ 80 years who had elective surgery for Stage I-III colon cancer in four Finnish centres. The prospectively collected data included comorbidities, functional status, postoperative outcomes and long-term survival. Univariate and multivariate Cox regression analysis were conducted to determine factors associated with long-term survival. Results A total of 386 surgical patients were included, of whom 357 survived over 3 months. Survival rates for all patients at 1, 3 and 5 years were 85%, 66% and 55%, compared to 92%, 71% and 59% for patients alive 3 months postoperatively, respectively. Higher age, American Society of Anesthesiologists (ASA) score ≥ 4, Charlson Comorbidity Index ≥ 6, tumour Stage III, open compared to laparoscopic surgery and severe postoperative complications were independently associated with reduced overall survival. Higher age (hazard ratio 1.97, 1.14-3.40), diabetes (1.56, 1.07-2.27), ASA score ≥ 4 (3.27, 1.53-6.99) and tumour Stage III (2.04, 1.48-2.81) were the patient-related variables affecting survival amongst those surviving more than 3 months postoperatively. Median survival time for patients given adjuvant chemotherapy was 5.4 years, compared to 3.3 years for patients not given postoperative treatment. Conclusions Fit aged colon cancer patients can achieve good long-term outcomes and survival with radical, minimally invasive surgical treatment, even with additional chemotherapy.

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Section: Discussionmentioning

confidence: 75%

Long‐term survival following elective colon cancer surgery in the aged. A population‐based cohort study

et al. 2020

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“…Especially in frail patients, these complications can lead to permanent functional loss and negatively influence survival and long‐term quality of life . The benefits of surgery should therefore be carefully weighed against these negative sequelae . For this purpose, there has been increasing attention for methods to identify frail patients in recent years .…”

Section: Introductionmentioning

confidence: 99%

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Weerink

Hoorn

Leeuwen

et al. 2020

J cachexia sarcopenia muscle

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Background Sarcopenia might function as an indicator for frailty, and as such as a risk factor for the development of postoperative complications. The aim of this study was to meta‐analyse the relation between preoperative sarcopenia and the development of severe postoperative complications in patients undergoing oncological surgery. Methods PubMed and Embase databases were systematically searched from inception until May 2018. Included were studies reporting on the incidence of severe postoperative complications and radiologically determined preoperative sarcopenia. Studies reporting the skeletal muscle as a continuous variable only were excluded. Data were extracted independently by two reviewers. Random effect meta‐analyses were applied to estimate the pooled odds ratio (OR) with 95% confidence intervals (95% CI) for severe postoperative complications, defined as Clavien‐Dindo grade ≥3, including 30‐day mortality. Heterogeneity was evaluated with I2 testing. Analyses were performed overall and stratified by measurement method, tumour location and publication date. Results A total of 1924 citations were identified, and 53 studies (14 295 patients) were included in the meta‐analysis. When measuring the total skeletal muscle area, 43% of the patients were sarcopenic, versus 33% when measuring the psoas area. Severe postoperative complications were present in 20%, and 30‐day mortality was 3%. Preoperative sarcopenia was associated with an increased risk of severe postoperative complications (ORpooled: 1.44, 95% CI: 1.24–16.8, P<0.001, I2=55%) and 30‐day mortality (ORpooled: 2.15, 95% CI: 1.46–3.17, P<0.001, I2=14%). A low psoas mass was a stronger predictor for severe postoperative complications compared with a low total skeletal muscle mass (ORpooled: 2.06, 95% CI: 1.37–3.09, ORpooled: 1.32, 95% CI: 1.14–1.53, respectively) and 30‐day mortality [ORpooled: 6.17 (95% CI: 2.71–14.08, ORpooled: 1.80 (95% CI: 1.24–2.62), respectively]. The effect was independent of tumour location and publication date. Conclusions The presence of low psoas mass prior to surgery, as an indicator for sarcopenia, is a common phenomenon and is a strong predictor for the development of postoperative complications. The presence of low total skeletal muscle mass, which is even more frequent, is a less informative predictor for postoperative complications and 30‐day mortality. The low heterogeneity indicates that the finding is consistent over studies. Nevertheless, the value of sarcopenia relative to other assessments such as frailty screening is not clear. Research is needed in order to determine the place of sarcopenia in future preoperative risk stratification.

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“…Frail older patients are three to four times more likely to develop postoperative complications compared with non-frail older patients [4,5]. Moreover, the occurrence of complications has a considerable impact on the quality of life and the survival of older patients [6]. Together with the fact that hospital admissions have been shortened due to changes in modern health care [7], this highlights the necessity of prevention and early detection of postoperative complications in this population.…”

Section: Introductionmentioning

confidence: 99%

Perioperative telemonitoring of older adults with cancer: Can we connect them all?

Jonker¹,

Lahr²,

Festen³

et al. 2020

Journal of Geriatric Oncology

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Although the increasing cancer incidence in older patients is widely recognised, older patients remain underrepresented in clinical cancer trials and eHealth studies. The aim of this research is to identify technological and patient-related barriers to inclusion of this population in a clinical eHealth study. Material and Methods: This is a retrospective analysis of a prospective cohort study with older patients (≥ 65 years) undergoing cancer-related surgery, who were identified for a perioperative telemonitoring study. Reasons for ineligibility and refusal had been prospectively registered. Characteristics and postoperative outcomes were compared between participants and non-participants. Results: Between May 2018 and March 2020, 151 patients were assessed for eligibility, resulting in 65 participants and 86 non-participants. The main reason for ineligibility was lack of internet access at home (n = 16), while main reasons for refusal were perceived high mental burden (n = 46) and insufficient digital skills (n = 12). Compared with participants, non-participants were significantly older (mean age 75 vs. 73, p = 0.01); more often female (64% vs. 35%, p = 0.00), unmarried (42% vs. 8%, p = 0.01) living alone (38% vs. 19%, p = 0.02); had a higher ASA classification (43% vs. 19%, p = 0.00); often had polypharmacy (67% vs. 43%, p = 0.00); and were more often discharged to skilled nursing facilities (0% vs. 15%, p = 0.00). Conclusion: Our results confirm the underrepresentation of older female patients with little support from a partner and higher comorbidity. We should be aware of technological and patient-related barriers to including older adults with cancer, in order to avoid further dividing patients with low and high digital health literacy.

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

Cited by 49 publications

References 47 publications

Long‐term survival following elective colon cancer surgery in the aged. A population‐based cohort study

Long‐term survival following elective colon cancer surgery in the aged. A population‐based cohort study

Low skeletal muscle mass and postoperative morbidity in surgical oncology: a systematic review and meta‐analysis

Perioperative telemonitoring of older adults with cancer: Can we connect them all?

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