Outcomes and adverse factors for endoscopic mucosal resection (EMR) of colorectal polyps in elderly patients

Abstract

IntroductionEndoscopic mucosal resection (EMR) is an invaluable technique, however it is associated with significant risks. In the elderly in particular, the long-term survival benefits of polyp resection with EMR are unknown. The aim of this study was to determine the long-term outcomes in elderly patients who had undergone EMR and to identify any adverse factors.MethodA retrospective observational study on patients of 75 years of age or greater, who underwent EMR of colorectal polyps, in a single tertiary centre, from 2005 to 2014. Demographics of the patients, including Charlson Comorbidity Index (CCI), endoscopic and histological data, were reviewed to identify potential factors predicting outcomes.ResultsThe patients’ median age was 80 years. In total 239 procedures were performed in 206 unique patients. The complication rate was 1.6%. Mean overall survival was 6.7 years with only one patient dying from metastatic colorectal cancer (0.5%) and 49 dying from non-colorectal cancer conditions (24%). Age more than 79 years and CCI more than 2 were independent predictors of significantly shorter survival (p=<0.01). Gender, size of the removed polyps and total number of polyps were not statistically significantly affecting survival. Patients who had more than two colonoscopies were found to have a survival benefit (p=0.02).ConclusionEMR of colonic polyps is safe even for elderly patients. However, the decision to proceed to complex endoscopic therapy should be individualised considering the patients’ age and comorbidities. CCI can help to objectively assess the comorbid state of a patient prior to such decisions.

Safety of endoscopic mucosal resection of large colonic polyps in elderly patients: a systematic review and meta-analysis

“…There were 2 studies that compared outcomes of EMR between patients older and younger than 80 years [ 11 , 12 ]. One study reported the outcomes of EMR in patients over 75 years of age, and one reported outcomes in patients over 80 years of age without a comparative group [ 10 , 14 ]. Two studies compared outcomes in patients older and younger than 75 years [ 13 , 15 ].…”

Decreasing rates of colectomy for benign neoplasms: A nationwide analysis

“…While the reasons underlying these trends are yet to be fully elucidated, specific changes in management of geriatric patients may play an important role. Recent work has demonstrated the safety and efficacy of endoscopic mucosal resection among this population [ 49 , 50 ]. Further, given the known complications of colectomy, higher surgical risk profile, and rapidly growing cohort of elderly patients, these patients may be referred at greater frequency for endoscopic intervention [ 51 ].…”

Clinical and Economic Justification of Software Screening Performance of Colorectal Cancer at the Region Level

“…Сложность поставленной задачи состоит в различной стоимости медицинских технологий в разных странах, что не позволяет экстраполировать данные об эффективности затрат из одной страны в другую [31]. Так, в Австралии стоимость одного года продления жизни больным КРР благодаря скрининговым программам, составляет 16632$, в США -до 22000$, в Европе -до 5000$ [17,19,23]. Однако несомненная экономическая целесообразность скрининга КРР на данный момент не вызывает сомнений у специалистов США и большинства стран Европы [16].…”

“…Многие страны, в том числе Российская Федерация, выполняют рекомендации ВОЗ, приняв за формальное пороговое значение готовности платить денежное выражение, равное 1-3 показателям уровня валового внутреннего продукта (ВВП) на душу населения. В применении к данному критерию, целевая реализация скрининга КРР также демонстрирует результаты высокоэффективного экономического вложения [17,19,23].…”

“…Это люди моложе 50 лет, которые не соответствуют рекомендациям по скринингу [4,22]. С другой стороны, доказано, что эндоскопическая резекция полипов толстой кишки безопасна даже для пожилых пациентов 80 лет и старше [23]. В связи с этим оптимальный возраст для скрининга КРР уже сегодня подвергается пересмотру [21].…”