Minimizing the impact of colorectal surgery in the older patient: The role of minimally invasive surgery in the geriatric population

Kolarsick, Paul; Sacchi, Matteo; Spinelli, Antonino; Wexner, Steven D.

doi:10.1016/j.ejso.2019.12.019

Cited by 12 publications

(7 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In previous studies, severe postoperative complications have also been associated with mortality 28 , 29 ; however, the 6.6 per cent 1-year mortality rate for all patients was low, showing convergent development with earlier studies 10 , 30 . The enhanced recovery after surgery programme and minimally invasive surgery, which have been shown to benefit postoperative outcomes, were well established at the recruiting hospitals 31 . Consequently, comprehensive preoperative assessment of risks for adverse events and allowing sufficient time for patients’ preoperative medical optimization is recommended.…”

Section: Discussionmentioning

confidence: 99%

One-year functional outcomes of patients aged 80 years or more undergoing colonic cancer surgery: prospective, multicentre observational study

et al. 2022

View full text Add to dashboard Cite

Background Older patients are at high risk of experiencing delayed functional recovery after surgical treatment. This study aimed to identify factors that predict changes in the level of support for activities of daily living and mobility 1 year after colonic cancer surgery. Methods This was a multicentre, observational study conforming to STROBE guidelines. The prospective data included pre-and postoperative mobility and need for support in daily activities, co-morbidities, onco-geriatric screening tool (G8), clinical frailty scale (CFS), operative data, and postoperative surgical outcomes. Results A total of 167 patients aged 80 years or more with colonic cancer were recruited. After surgery, 30 per cent and 22 per cent of all patients had increased need for support and decreased motility. Multivariableanalysis with all patients demonstrated that preoperative support in daily activities outside the home (OR 3.23, 95 per cent c.i. 1.06 to 9.80, P = 0.039) was associated with an increased support at follow-up. A history of cognitive impairment (3.15, 1.06 to 9.34, P = 0.038) haemoglobin less than 120 g/l (7.48, 1.97 to 28.4, P = 0.003) and discharge to other medical facilities (4.72, 1.39 to 16.0, P = 0.013) were independently associated with declined mobility. With functionally independent patients, haemoglobin less than 120 g/l (8.31, 1.76 to 39.2, P = 0.008) and discharge to other medical facilities (4.38, 1.20 to 16.0, P = 0.026) were associated with declined mobility. Conclusion Increased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicts an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should focus on anaemia correction, nutritional status, and mobility with detailed rehabilitation plan.

show abstract

Section: Discussionmentioning

confidence: 99%

One-year functional outcomes of patients aged 80 years or more undergoing colonic cancer surgery: prospective, multicentre observational study

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Elderly patients more often have a comorbidity, disability, geriatric diseases and consequently physical impairment, and they tend to undergo abdominal surgery less often because of the higher risk of perioperative complications [ 4 , 9 ]. In order to reduce these complications, multimodal therapy modifications are often used in elderly rectal cancer patients, such as reduction of chemotherapy dose or choosing short-course radiotherapy (RT) with delayed surgery [ 7 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Age on Multimodality Treatment and Survival in Locally Advanced Rectal Cancer Patients

Nes

Heil

Verhoeven

et al. 2022

Cancers

View full text Add to dashboard Cite

Background: Optimal treatment for locally advanced rectal cancer is neoadjuvant (chemo)radiation followed by radical surgery. This is challenging in the aging population because of frequently concomitant comorbidity. We analyzed whether age below and above 70 years is associated with differences in treatment strategy and outcome in this population-based study. Methods: Data between 2008 and 2016 were extracted from the Netherlands Cancer Registry with follow-up until 2021. Differences in therapy, referral and outcome were analyzed using χ2 tests, multivariable logistic regression and relative survival analysis. Results: In total, 6524 locally advanced rectal cancer patients were included. A greater proportion of patients <70 years underwent resection compared to older patients (89% vs. 71%). Patients ≥70 years were more likely treated with neoadjuvant radiotherapy (OR 3.4, 95% CI 2.61–4.52), than with chemoradiation (OR 0.3, 95% CI 0.23–0.37) and less often referred to higher volume hospitals for resection (OR 0.7, 95% CI 0.51–0.87). Five-year relative survival after resection following neoadjuvant therapy was comparable and higher for both patients <70 years and ≥70 years (82% and 77%) than after resection only. Resection only was associated with worse survival in the elderly compared to younger patients (56% vs. 75%). Conclusion: Elderly patients with locally advanced rectal cancer received less intensive treatment and were less often referred to higher volume hospitals for surgery. Relative survival was good and comparable after optimal treatment in both age groups. Effort is necessary to improve guideline adherence, and multimodal strategies should be tailored to age, comorbidity and performance status.

show abstract

“…These risks usually impact the surgeon’s decision on the surgical plan, especially for elderly patients with left-sided CRC where Hartmann’s procedure may be selected instead of primary anastomosis [ 15 , 16 ]. Further, advanced age had initially been viewed as a relative contraindication to laparoscopic surgery [ 17 ], and minimally invasive surgery (MIS) is still underutilized in the elderly [ 18 ]. Since elderly patients are significantly underrepresented in the clinical studies due to careful participant selection by common age, performance status, or comorbidities restrictions [ 19 , 20 ], there is a lack of evidence for the most appropriate surgical strategies in such patients.…”

Section: Introductionmentioning

confidence: 99%

Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer

et al. 2021

View full text Add to dashboard Cite

Background The proportion of elderly colorectal cancer (CRC) patients requiring surgery is increasing. Colorectal resection for left-sided cancers is the most controversial as the primary anastomosis or end-colostomy and open or minimally invasive approaches are available. Therefore, this study was conducted to investigate the short- and long-term outcomes in elderly patients after resection with primary anastomosis for left-sided CRC. Methods The cohort study included left-sided colorectal cancer patients who underwent resection with primary anastomosis. The participants were divided into non-elderly (≤75 years) and elderly (> 75 years) groups. Short- and long-term postoperative outcomes were investigated. Results In total 738 (82%) and 162 (18%) patients were allocated to non-elderly and elderly groups, respectively. Minimally invasive surgery (MIS) was less prevalent in the elderly (42.6% vs 52.7%, p = 0.024) and a higher proportion of these suffered severe or lethal complications (15.4% vs 9.8%, p = 0.040). MIS decreased the odds for postoperative complications (OR: 0.41; 95% CI: 0.19–0.89, p = 0.038). The rate of anastomotic leakage was similar (8.5% vs 11.7%, p = 0.201), although, in the case of leakage 21.1% of elderly patients died within 90-days after surgery. Overall- and disease-free survival was impaired in the elderly. MIS increased the odds for long-term survival. Conclusions Elderly patients suffer more severe complications after resection with primary anastomosis for left-sided CRC. The risk of anastomotic leakage in the elderly and non-elderly is similar, although, leakages in the elderly seem to be associated with a higher 90-day mortality rate. Minimally invasive surgery is associated with decreased morbidity in the elderly.

show abstract

Minimizing the impact of colorectal surgery in the older patient: The role of minimally invasive surgery in the geriatric population

Cited by 12 publications

References 65 publications

One-year functional outcomes of patients aged 80 years or more undergoing colonic cancer surgery: prospective, multicentre observational study

One-year functional outcomes of patients aged 80 years or more undergoing colonic cancer surgery: prospective, multicentre observational study

Impact of Age on Multimodality Treatment and Survival in Locally Advanced Rectal Cancer Patients

Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer

Contact Info

Product

Resources

About