Surgery for Colorectal Cancer in Elderly Patients: How Could We Improve Early Outcomes ?

Bouassida, Mounir

doi:10.7860/jcdr/2015/12213.5973

Cited by 14 publications

(15 citation statements)

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“…Emergency surgical treatment of CRC is potential promoter of permanent disability in frail and vulnerable patients, and discharge is often to long-term care facilities. [29,30] In the literature, longer hospitalization is often due to high incidence of Post Operative Delirium (POD). [31] Ansaloni et al affirmed that to minimize POD, associated risk factors of comorbidity, cognitive impairment, psychopathology, and abnormal glycemic control must be identified and treated.…”

Section: Discussionmentioning

confidence: 99%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Colorectal cancer (CRC) is predominantly a disease of elderly people. Cancer in nonagenarian patients presents an ethical dilemma for surgeons and oncologists, and management of this group of patients in emergency for complicated CRC is debated. Presently described is retrospective study reporting experience of 6 departments of emergency surgery with management of nonagenarian patients sent to emergency surgery for CRC complications. METHODS: Data concerning patients aged over 90 years hospitalized from January 2011 to June 2015 in 6 departments of emergency surgery for complicated CRC were retrospectively analyzed. Data were collected in a dedicated database. Statistical analysis was conducted using IBM software SPSS 22 (IBM Corp., Armonk, NY, USA); statistical significance was set at p=0.05. RESULTS: In the period of study,19 patients aged over 90 underwent surgery in emergency department for complicated CRC. Of the total, 52.63% were female, with sex ratio F:M of 1.11:1. Mean age was 92.52 years (range: 90-97 years; SD 1.49). Preoperative assessment of surgical risk was made using American Society of Anesthesiologists (ASA) score. There was no statistically significant difference in terms of in-hospital mortality between patients with ASA score ≤ 3 and patients with an ASA score >3. Primary anastomosis was performed in 6 of 19 patients (31.57%), all of whom had right-side colon cancer. Diverting stoma was created for 12 of 19 patients (63.15%). There was a statistically significant difference in incidence of postoperative complications between patients with right-side colon cancer and patients with left-side colon cancer (p=0.0498). Mean length of hospital stay was 12.78 days (range: 2-31 days; SD 6.31). In-hospital mortality rate was 21.05% (n=4). At follow up, overall survival was 47.36% (n=9). CONCLUSION: Elective surgery is the best way to manage CRC in all patients affected. Emergency surgery for CRC complications in patients over 90 is feasible with careful preoperative selection and evaluation of the patient. One-stage surgery is the best choice, in selected patients. Two-and three-stage surgery is indicated in case of peritonitis, for frail patients, for hemodynamically unstable patients. If there is high risk of anastomotic leakage, decompressive stoma is suggested as bridge to elective surgery, and in advanced neoplastic disease, as palliative procedure. In emergency setting, diverting stoma is a good surgical option in nonagenarian patients to decrease surgical risk, morbidity, and mortality; however, clinical randomized controlled trials are necessary to confirm this.

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Section: Discussionmentioning

confidence: 99%

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Simone

Ansaloni²,

Tarasconi³

et al. 2016

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

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“…Many authors reported that emergency surgery for CRC in patients over 90 years of age can be performed safely [15,26,29,43] . Old age itself is not an independent negative prognostic factor for CRC surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Several studies found similar disease specific survival for elderly and young colorectal cancer patients [28][29][30][31] , but difference in overall survival; this means that the increase of mortality in oncogeriatric patients is due to competing causes of death and not to CRC. Consequently decreased survival in the elderly is mainly due to differences in early mortality [28,[32][33][34][35][36] .…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 95%

“…Consequently decreased survival in the elderly is mainly due to differences in early mortality [28,[32][33][34][35][36] . Some authors showed that time between admission and surgery doesn't increase morbidity and mortality rates [29] ; others, demonstrated that delays in performing emergency surgery in elderly patients leads to higher complication rates [3,30] . Lenght of hospital stay is longer for patients aged over ninety than for younger patients and surgical treatment of CRC in emergency condition is a potential promoter of permanent disability in frail and vulnerable nonagenarian patients.…”

Section: Surgical Techniques and Outcomesmentioning

confidence: 99%

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Emergency Surgery for Colorectal Cancer in Patients Aged Over 90 Years: Review of the Recent Literature

Belinda

Catena

2016

Journal of Tumor

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derly people; approximately 60% of patients are aged >70 years at time of diagnosis and 43% of cases are aged >75 years in the western countries [1][2][3] . These proportions will likely continue to increase in the near future, because of the increasing percentage of people living past ninety years, a phenomenon associated with the aging world population.In Italy, according to the Italian National Institute of Statistics (ISTAT) data, the population aged 85 and older will increase from 2.8% in 2011 to 7.8% in 2050, reaching an average life expectancy of 85.3 years for males and 90.5 years for females.This highly significant demographic change in modern society has an important impact on health care, especially in cancer care, as cancer in people aged over 90, poses an ethical dilemma for surgeons and oncologists: non operative management or medical and/or surgical treatment? To treat is an over treatment?In clinical practice, the management of this group of patients is frequently suboptimal, consequently an increasing number of nonagenarian CRC patients are admitted in emergency departments, requiring surgical treatment.Generally, emergency abdominal procedures are associated with increased morbidity and mortality rates, particularly for frail elderly patients. The emergency surgeon often has the crucial role of selecting which patients to submit to surgery, balancing the benefits and the high surgical risk associated with comorbidities.Another important issue to consider is the high costs of the postoperative care for this group of patients which frequently demand rehabilitation and longer recovery, even after minor surgery.We decided to review the recent literature to discuss current strategies in the management of oncogeriatric patients aged over ninety in emergency. MATERIALS AND METHODSWe performed a search by Cochrane Library, MEDLINE, and EMBASE for potentially relevant scientific articles on emergency surgery for colorectal cancer in nonagenarian patients. We considered in our review all the scientific papers published in the last ten years up to June 2015. We included in this study randomized controlled ABSTRACTThe aging of the world population is leading to an increase in the number of patients aged over ninety needing for a surgical treatment in emergency setting. Colorectal cancer in people over 90 years of age represents an ethical dilemma for surgeons and oncologists, above all when the neoplastic disease is advanced and complicated by obstruction and/or perforation. The emergency surgeon often has the crucial role of selecting which patients to submit to surgery, balancing the benefits and the high surgical risk associated with frailty, polipharmacy and comorbidities.We decided to review the recent literature to discuss the latest strate-gies in the management of colorectal cancer in emergency situations, for patients aged over ninety.

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“…Advanced age is an important and well-known factor for development of morbidity and mortality in both elective and emergency surgeries [9]. It is also one of the most affecting factor on the surgical outcomes of the patients who undergone urgent operation due to obstructed CRC [10,11]. Since this cancer is an elderly disease, a significant proportion of the patients have comorbid disorders, functional dependency, and limited life expectancy.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Postoperative Morbidity and Mortality in Obstructing Colorectal Cancer

Kılıç¹

2016

Ann Clin Anal Med

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ÖzetAmaç: Amacımız kolorektal kansere bağlı akut barsak tıkanıklığı nedeniyle acil ameliyat edilen hastalarda postoperatif morbidite ve mortaliteye etki eden faktörleri araştırmaktır. Gereç ve Yöntem: Perforasyonsuz tıkayıcı kolorektal kanser nedeniyle ameliyat edilen 43 hasta retrospektif olarak değerlendirildi. Postoperatif morbidite ve mortaliteyi etkileyen ana prognostik faktörleri belirlemek için lojistik regresyon analizi kullanıldı. Bulgular: Postoperatif dönemde 8 (%18.6) hastada mortalite görülür iken, 16 (%37.6) hastada postoperatif morbidite gelişti. Tek değişkenli analizde, 65 üzeri yaşın (p=0.034), eşlik eden sistemik hastalığın (p=0.035), ileri tümör evresinin (p=0.040) ve yüksek ASA skorunun (p=0.000) postoperatif morbidite gelişimi ile ilişkili olduğu bulundu. Öte yandan, 65 üzeri yaş (p=0.023), eşlik eden sistemik hastalık (p=0.014), yüksek ASA skoru (p=0.010) ve uzak metastaz varlığı (p=0.012) postoperatif mortalite ile ilgili risk faktörleri olarak tanımlan-dı. Lojistik regresyon analizi sonrası, yüksek ASA skoru (p=0.005) ve uzak metastaz varlığı (p=0.000), postoperatif mortalitenin bağımsız prognostik faktörleri olarak saptanırken, 65 yaş üzeri yaş (p=0.023) ve yüksek ASA skoru (p=0.000) postoperatif morbiditenin prognostik faktörler olarak belirlendi. Tartışma: İleri yaş ve eşlik eden sistemik hastalık varlığı tıkayıcı kolorektal kanser için acil ameliyat edilen hastalarda postoperatif morbidite ve mortaliteyi artırır. ASA skoru, hem morbidite hem de mortalite için güçlü bir prognostik faktör olarak, preoperatif risk sınıflandırması ve cerrahi planlamada kolaylıkla kullanılabilir. Anahtar KelimelerKolorektal Kanser; Barsak Tıkanıklığı; Morbidite; Mortalite Abstract Aim: Our aim is to investigate the factors affecting on postoperative morbidity and mortality in patients who underwent emergency surgery for acute intestinal obstruction due to colorectal cancer. Material and Method: Fortythree patients who was operated because of acute obstructing colorectal cancer without perforation were retrospectively evaluated. Logistic regression analysis was used to identify the main prognostic factors affecting postoperative morbidity and mortality. Results: Postoperative morbidity was developed in 16 (37.6%) patients while mortality was seen in 8 (18.6%) patients during the postoperative period. In univariate analysis, age above 65 years (p=0.034), accompanying systemic disease (p=0.035), advanced tumor stage (p=0.040), and high ASA score (p=0.000) were found to be associated with the development of postoperative morbidity. On the other hand, age above 65 years (p=0.023), accompanying systemic disease (p=0.014), high ASA score (p=0.010), and presence of distant metastasis (p=0.012) were identified as the risk factors related to postoperative mortality. After logistic regression analysis, age above 65 years (p=0.023) and high ASA score (p=0.000) were determined as the prognostic factors of postoperative morbidity, while high ASA score (p=0.005) and presence of distant metastasis (p=0.000) were found to ...

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Surgery for Colorectal Cancer in Elderly Patients: How Could We Improve Early Outcomes ?

Abstract: Patient characteristics in both groups were compared using Chi-square with Fisher's exact test for qualitative variables. The normality of data was assessed by the the Shapiro-Wilk test and the Kolmogorov-Smirnov test. The Z Kolmogorov-Smirnov statistical

Cited by 14 publications

References 16 publications

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency?

Emergency Surgery for Colorectal Cancer in Patients Aged Over 90 Years: Review of the Recent Literature

Factors Affecting Postoperative Morbidity and Mortality in Obstructing Colorectal Cancer

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