Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study

Abstract

Purpose Patients aged > 80 years represent an increasing proportion of colon cancer diagnoses. Selecting patients for elective surgery is challenging because of possibly compromised health status and functional decline. The aim of this retrospective, population-based study was to identify risk factors and health measures that predict short-term mortality after elective colon cancer surgery in the aged. Methods All patients > 80 years operated electively for stages I-III colon cancer from 2005 to 2016 in four Finnish hospitals were included. The prospectively collected data included comorbidities, functional status, postoperative surgical and medical outcomes as well as mortality data. Results A total of 386 patients (mean 84.0 years, range 80-96, 56% female) were included. Male gender (46% vs 35%, p = 0.03), higher BMI (51% vs 37%, p = 0.02), diabetes mellitus (51% vs 37%, p = 0.02), coronary artery disease (52% vs 36%, p = 0.003) and rheumatic diseases (67% vs 39%, p = 0.03) were related to higher risk of complications. The severe complications were more common in patients with increased preoperative hospitalizations (31% vs 15%, p = 0.05) and who lived in nursing homes (30% vs 17%, p = 0.05). The 30-day and 1-year mortality rates were 6.0% and 15% for all the patients compared with 30% and 45% in patients with severe postoperative complications (p < 0.001). Severe postoperative complications were the only significant patient-related variable affecting 1-year mortality (OR 9.60, 95% CI 2.33-39.55, p = 0.002). Conclusions The ability to identify preoperatively patients at high risk of decreased survival and thus prevent severe postoperative complications could improve overall outcome of aged colon cancer patients.

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

“…In conclusion, this study extends our earlier findings [8] and suggests that aged colon cancer patients who are physically and functionally fit to survive surgery can achieve acceptable long‐term outcomes and survival with radical surgical treatment and additional chemotherapy. Further prospective studies are required to identify patients who are at risk of complications and able to recover from them as well as the effects of colon cancer surgery on the quality of life in long‐term follow‐up.…”

“…However, those who survived the first three postoperative months had survival rates comparable to those with no or mild complications. Thus, preventing complications through preoperative health evaluation is essential, especially for high‐risk patients [8].…”

“…The aim of this study was to analyse the long‐term survival and causes of death in a consecutive population‐based cohort of aged patients having colon cancer surgery. Because postoperative complications are a major risk factor of short‐term mortality [8], the focus in this study was especially on the patients who survived at least 3 months after surgery.…”

The Impact of Comorbid Diabetes on Short-Term Postoperative Outcomes in Stage I/II Colon Cancer Patients Undergoing Open Colectomy

“…Although Niemelainen et al [ 17 ] previously reported that comorbid diabetes increases the likelihood of postoperative complications in older patients with stage I-III colon cancer undergoing open or laparoscopic surgery [ 17 ], the present analysis of the NIS (2005-2010) unexpectedly revealed that comorbid diabetes was significantly associated with lower risks of not only postoperative complications but also in-hospital mortality in stage I/II colon cancer patients undergoing open colectomy. Patients with uncomplicated diabetes had significantly lower percentages of in-hospital mortality and postoperative complications than those without diabetes, but patients with complicated diabetes had a significantly higher percentage of postoperative complications than those without diabetes, suggesting that the putative protective role of comorbid diabetes may be mainly contributed by uncomplicated diabetes.…”

“…However, most studies that investigated the effect of comorbid diabetes on short-term surgical outcomes in colorectal cancer did not distinguish colon cancer from rectal cancer [ 13 – 16 ]. Notably, a population-based study specifically focusing on stage I-III colon cancer revealed that comorbid diabetes is associated with elevated risk of postoperative complications in patients 80 and older after either open resection or laparoscopic resection in Finland [ 17 ].…”