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Keller DS, Curtis N, Burt HA, Ammirati CA, Collings AT, Polk HC, Carrano FM, Antoniou SA, Hanna N, Piotet LM, Hill S, Cuijpers ACM, Tejedor P, Milone M, Andriopoulou E, Kontovounisios C, Leeds IL, Awad ZT, Barber MW, Al-Mansour M, Nassif G, West MA, Pryor AD, Carli F, Demartines N, Bouvy ND, Passera R, Arezzo A, Francis N. EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults. Surg Endosc 2024; 38:4104-4126. [PMID: 38942944 PMCID: PMC11289045 DOI: 10.1007/s00464-024-10977-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery. METHODS Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology. RESULT Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery. CONCLUSIONS MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.
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Affiliation(s)
- Deborah S Keller
- Department of Digestive Surgery, University of Strasbourg, Strasbourg, FR, USA
| | - Nathan Curtis
- Surgical Unit, Dorset County Hospital, Dorchester, Dorset, UK
| | | | | | - Amelia T Collings
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hiram C Polk
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Francesco Maria Carrano
- Department of General and Minimally Invasive Surgery, Busto Arsizio Circolo Hospital, ASST-Valle Olona, Varese, Italy
| | - Stavros A Antoniou
- Department of General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nader Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Sarah Hill
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Anne C M Cuijpers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia Tejedor
- Department of Colorectal Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marco Milone
- Department of Clinical and Surgical Gastrointestinal Diseases, University of Naples "Federico II", Via Pansini 5, Naples, Italy
| | - Eleni Andriopoulou
- Department of Surgery, Hellenic Red Cross Korgialeneio Benakeio NHS, Athens, Greece
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Campus and the Royal Marsden Hospital, London, UK
| | - Ira L Leeds
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Meghan Wandtke Barber
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Mazen Al-Mansour
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - George Nassif
- Department of Colorectal Surgery, AdventHealth, Orlando, FL, USA
| | - Malcolm A West
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
- Complex Cancer and Exenterative Service, University Hospitals Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton, Southampton, UK
| | - Aurora D Pryor
- Long Island Jewish Medical Center and System Chief for Bariatric Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA
| | - Franco Carli
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | - Nicole D Bouvy
- Innovative Surgical Techniques, Endoscopic and Endocrine Surgery, Department of Surgery, Maastricht University Medical Center, Amsterdam, Netherlands
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Turin, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Nader Francis
- Department of Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK.
- The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK.
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Ammirati CA, Passera R, Beltrami E, Peluso C, Francis N, Arezzo A. Laparoscopic and robotic surgery for colorectal cancer in older patients: a systematic review and meta-analysis. MINIM INVASIV THER 2024:1-17. [PMID: 38946054 DOI: 10.1080/13645706.2024.2360094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/21/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION As life expectancy has been increasing, older patients are becoming more central to the healthcare system, leading to more intensive care use and longer hospital stays. Nevertheless, advancements in minimally invasive surgical techniques offer safe and effective options for older patients with colorectal diseases. This study aims to provide comprehensive evidence on the role of minimally invasive surgery in treating colorectal diseases in older patients. MATERIAL AND METHODS All articles directly compared the minimally invasive approach with open surgery in patients aged ≥65 years. The present metanalysis took 30-day complications as primary outcomes. Length of hospital stay, readmission, and 30-day mortality were also assessed, as secondary outcomes. Further subgroup analyses were carried out based on surgery setting, lesion features, and location. RESULTS After searching the main databases, 84 articles were included. Evaluation of 30-day complications rate, length of hospital stay, and 30-day mortality significantly favored minimally invasive approaches. The outcome readmission did not show any significant difference. CONCLUSIONS The current metanalysis demonstrates clear advantages of minimally invasive techniques over open surgery in colorectal procedures for older patients, particularly in reducing complications, mortality, and hospitalization. This suggests that prioritizing these techniques, based on available expertise and facilities, could improve outcomes and quality of care for older patients undergoing colorectal surgery.
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Affiliation(s)
| | - Roberto Passera
- Nuclear Medicine Division, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Elsa Beltrami
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Chiara Peluso
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | - Nader Francis
- Department of Colorectal Surgery, Yeovil District Hospital Foundation Trust, Yeovil, UK
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Turin, Torino, Italy
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Fujimoto T, Tamura K, Nagayoshi K, Mizuuchi Y, Oh Y, Nara T, Matsumoto H, Horioka K, Shindo K, Nakata K, Ohuchida K, Nakamura M. Osteosarcopenia: the coexistence of sarcopenia and osteopenia is predictive of prognosis and postoperative complications after curative resection for colorectal cancer. Surg Today 2024:10.1007/s00595-024-02883-1. [PMID: 38880803 DOI: 10.1007/s00595-024-02883-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/20/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To establish if osteosarcopenia is related to postoperative complications, prognosis, and recurrence of colorectal cancer (CRC) after curative surgery. METHODS The clinical data of 594 patients who underwent curative resection for CRC between January, 2013 and December, 2018 were analyzed retrospectively to examine the relationship between clinicopathological data and osteosarcopenia. The following definitions were used: sarcopenia, low skeletal muscle mass index; osteopenia, low bone mineral density on computed tomography at the level of the 11th thoracic vertebra; and osteosarcopenia, sarcopenia with osteopenia. RESULTS Osteosarcopenia was identified in 98 patients (16.5%) and found to be a significant risk factor for postoperative complications (odds ratio 2.53; p = 0.011). The 5-year overall survival (OS) and recurrence-free survival (RFS) rates of the patients with osteosarcopenia were significantly lower than those of the patients without osteosarcopenia (OS: 72.5% and 93.9%, respectively, p < 0.0001; RFS: 70.8% and 92.4%, respectively, p < 0.0001). Multivariate analysis identified osteosarcopenia as an independent prognostic factor associated with OS (hazard ratio 3.31; p < 0.0001) and RFS (hazard ratio 3.67; p < 0.0001). CONCLUSION Osteosarcopenia may serve as a predictor of postoperative complications and prognosis after curative surgery for CRC.
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Affiliation(s)
- Takaaki Fujimoto
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Koji Tamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kinuko Nagayoshi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yusuke Mizuuchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yoshio Oh
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Tsukasa Nara
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Hiroshi Matsumoto
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kohei Horioka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Navarra A, Porcellini I, Mongelli F, Popeskou SG, Grass F, Christoforidis D. Long-term outcomes in elderly patients after elective surgery for colorectal cancer within an ERAS protocol: a retrospective analysis. Langenbecks Arch Surg 2023; 408:438. [PMID: 37978074 DOI: 10.1007/s00423-023-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The number of elderly patients with a diagnosis of colorectal cancer (CRC) is increasing. Considering short life expectancy and multiple comorbidities, surgery may not always be the best treatment option. METHODS We included all consecutive patients aged 80 years and older who underwent elective resection for CRC following Enhanced Recovery after Surgery (ERAS) protocol between January 2011 and May 2021. The primary endpoint was overall survival, secondary endpoints were 30-day morbidity, and the rate of return to pre-operative living conditions 3 months after surgery. RESULTS Ninety-four patients were included. Mean age was 84.6 ± 3.6 years, 49 patients (52%) were female. Most patients (77.6%) were ASA score ≥ 3. Laparoscopic resections were performed in 85 patients (90.4%), involving 69 (73.4%) colonic and 25 (26.6%) rectal resections. A stoma was constructed in 22 patients (23%), and reversed in 12 (54.5%). Twenty-two patients (23.4%) experienced a Clavien-Dindo ≥ 3 complication, and 2 patients (2.1%) died. The median length of hospital stay was 8 (interquartiles: 6-15) days. Sixty-six patients (70.2%) were discharged home directly and 26 (27.7%) to rehabilitation or postacute care institutes. At three months after surgery, eighty-two patients (96.5%) returned to their pre-operative living conditions directly or after short-term rehabilitation. Mean follow-up was 53 ± 33 months, estimated 5-year overall survival was 60.3% (95%CI 49.5-71.1%), and disease-free survival was 86.3% (95%CI 78.1-94.4%). CONCLUSIONS Our study suggests that elderly patients undergoing elective surgery have a high potential to return to preoperative living conditions and good overall- and disease-free survivals, despite significant postoperative morbidity.
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Affiliation(s)
- Andrea Navarra
- University of Lausanne, Quartier Centre, 1015, Lausanne, Switzerland
| | - Iride Porcellini
- Department of Surgery, Ospedale Regionale Di Lugano, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, EOC, Via Ospedale 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Science, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland.
| | | | - Fabian Grass
- University of Lausanne, Quartier Centre, 1015, Lausanne, Switzerland
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Dimitri Christoforidis
- Department of Surgery, Ospedale Regionale Di Lugano, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Science, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Passuello N, Polese L, Ometto G, Grossi U, Mammano E, Vittadello F, Frasson A, Tessari E, Bartolotta P, Gregori D, Sarzo G. Outcomes of Laparoscopic Surgery in Very Elderly Patients with Colorectal Cancer: A Survival Analysis and Comparative Study. J Clin Med 2023; 12:7122. [PMID: 38002734 PMCID: PMC10672623 DOI: 10.3390/jcm12227122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Colorectal cancer (CRC) is a global health concern, particularly among the elderly population. This study aimed to assess the impact of laparoscopic surgery on CRC patients aged ≥80 years. (2) Methods: We conducted a retrospective analysis of prospectively collected data from consecutive CRC patients who underwent surgery at our institution between July 2018 and July 2023. The patients were categorized into three groups: those aged over 80 who underwent laparoscopic surgery (Group A), those aged over 80 who underwent open surgery (Group B), and those under 80 who underwent laparoscopic surgery (Group C). We examined various clinical and surgical parameters, including demographic data, medical history, surgical outcomes, and survival. (3) Results: Group A (N = 113) had shorter hospital stays than Group B (N = 23; p = 0.042), with no significant differences in complications or 30-day outcomes. Compared to Group C (N = 269), Group A had higher comorbidity indices (p < 0.001), more emergency admissions, anemia, low hemoglobin levels, colonic obstruction (p < 0.001), longer hospital stays (p < 0.001), and more medical complications (p = 0.003). Laparotomic conversion was associated with obstructive neoplasms (p < 0.001), and medical complications with ASA scores (p < 0.001). Both the medical and surgical complications predicted adverse 30-day outcomes (p = 0.007 and p < 0.001). Survival analysis revealed superior overall survival (OS) in Group A vs. Group B (p < 0.0001) and inferior OS vs. Group C (p < 0.0001). After a landmark analysis, the OS for patients aged 80 or older and those under 80 appeared to be similar (HR 2.55 [0.75-8.72], p = 0.136). (4) Conclusions: Laparoscopic surgery in very elderly CRC patients shows comparable oncological outcomes and surgical complications to younger populations. Survival benefits are influenced by age, comorbidities, and medical complications. Further prospective multicenter studies are needed in order to validate these findings.
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Affiliation(s)
- Nicola Passuello
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Lino Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy;
| | - Giulia Ometto
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Ugo Grossi
- Department of Surgery, Oncology and Gastroenterology, University of Padua, 35128 Padua, Italy;
- Surgery Unit 2, Regional Hospital Treviso, 31100 Treviso, Italy
| | - Enzo Mammano
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Fabrizio Vittadello
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Alvise Frasson
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Emanuela Tessari
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (P.B.); (D.G.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35121 Padua, Italy; (P.B.); (D.G.)
| | - Giacomo Sarzo
- OSA General Surgery, Padua University Hospital, 35128 Padua, Italy; (N.P.); (G.O.); (E.M.); (F.V.); (A.F.); (E.T.); (G.S.)
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Voutsadakis IA. Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1574. [PMID: 37763693 PMCID: PMC10535827 DOI: 10.3390/medicina59091574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
Background: An increasing proportion of the population of patients with cancer presents at an advanced age, increasing the challenges of successful and well-tolerated treatments. In the older spectrum of the geriatric cancer patients, those older than 80 years old, challenges are even higher because of increasing comorbidities and decreasing organ function reserves. Methods: Studies regarding colorectal cancer presentation, treatment, and prognosis in patients older than 80 years old available in the literature were evaluated and were compiled within a narrative review. Molecular attributes of colorectal cancer in the subset of patients older than 80 years old in published genomic cohorts were also reviewed and were compared with similar attributes in younger patients. Results: Characteristics of colorectal cancer in octogenarians are in many aspects similar to younger patients, but patients older than 80 years old present more often with right colon cancers. Surgical treatment of colorectal cancer in selected patients over 80 years old is feasible and should be pursued. Adjuvant chemotherapy is under-utilized in this population. Although combination chemotherapy is in most cases not advisable, monotherapy with fluoropyrimidine derivatives is feasible and efficacious. Conclusions: Outcomes of colorectal cancer patients over the age of 80 years old may be optimized with a combination of standard treatments adjusted to the individual patient's functional status and organ reserves. Increased support for the older age group during their colorectal cancer treatment modalities would improve oncologic outcomes with decreasing adverse outcomes of therapies.
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Affiliation(s)
- Ioannis A. Voutsadakis
- Algoma District Cancer Program, Sault Area Hospital, 750 Great Northern Road, Sault Ste. Marie, ON P6B 0A8, Canada; or
- Section of Internal Medicine, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
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Zhao FQ, Jiang YJ, Xing W, Pei W, Liang JW. The safety and prognosis of radical surgery in colorectal cancer patients over 80 years old. BMC Surg 2023; 23:45. [PMID: 36855086 PMCID: PMC9972629 DOI: 10.1186/s12893-023-01938-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVE The purpose of this study was to assess the safety and feasibility of radical surgery and to investigate prognostic factors influencing in colorectal cancer (CRC) patients over the age of 80. METHODS Between January 2010 and December 2020, 372 elderly CRC patients who underwent curative resection at the National Cancer Center were enrolled in the study. Preoperative clinical characteristics, perioperative outcomes, and postoperative pathological features were all collected. RESULTS A total of 372 elderly patients with colorectal cancer were included in the study, including 226 (60.8%) men and 146 (39.2%) women. A total of 219 (58.9%) patients had a BMI < 24 kg/m2, and 153 (41.1%) patients had a BMI ≥ 24 kg/m2. The mean operation time and intraoperative blood loss were 152.3 ± 58.1 min and 67.6 ± 35.4 ml, respectively. The incidence of overall postoperative complications was 28.2% (105/372), and the incidence of grade 3-4 complications was 14.7% (55/372). In the multivariable Cox regression analysis, BMI ≥ 24 kg/m2 (HR, 2.30, 95% CI, 1.27-4.17; P = 0.006) and N1-N2 stage (HR: 2.97; 95% CI, 1.48-5.97; P = 0.002) correlated with worse CSS. CONCLUSION The findings of this study showed that radical resection for CRC is safe and feasible for patients over the age of 80. After radical resection, BMI and N stage were independent prognostic factors for elderly CRC patients.
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Affiliation(s)
- Fu-Qiang Zhao
- grid.414341.70000 0004 1757 0026 Department of Minimally Invasive Surgery, Beijing Chest Hospital, Capital Medical University; Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Yu-Juan Jiang
- grid.506261.60000 0001 0706 7839Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Wei Xing
- Department of General Surgery, Hebei Province Hospital of Chinese Medicine; Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, 050013, Hebei, China.
| | - Wei Pei
- grid.506261.60000 0001 0706 7839Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Jian-Wei Liang
- grid.506261.60000 0001 0706 7839Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
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