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

Abstract

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.

Short- and long-term outcome differences between patients undergoing left and right colon cancer surgery: cohort study

“…Although right hemicolectomy was considered to be a simpler procedure because of the omission of colocolic or colorectal anastomosis and better postoperative results than left hemicolectomy [ 7 – 9 ], current literature presents diverse data on short- and long-term outcomes. Some studies suggest that patients after left colectomy face more postoperative complications, including increased surgical site infections, a higher incidence of ureteral injuries, and a greater conversion rate to open surgery, along with an extended hospital stay [ 10 ], especially for elderly patients due to anastomotic leak that also leads to higher mortality risk [ 11 ]. Conversely, other reports argue that complications are more frequent in patients undergoing right colectomy [ 12 ].…”

The association of postoperative morbidity and age on 5‐year survival after colorectal surgery in the elderly population: a nationwide cohort study

“…Globally, the proportion of persons aged 60 is growing and is estimated to double by 2050 [1]. The treatment of colorectal cancer in elderly patients can be challenging as every second patient above 80 years of age suffers from postoperative complications related to colorectal cancer surgery [2–4]. Geriatric individuals have a significantly different phenotype than younger patients [5, 6], yet most treatment guidelines do not differentiate treatment across age groups.…”