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Thungathurthi K, Wei M, Othman B, Jain A, Girdlestone P, Chandra R. Outcomes in octogenarians following elective colorectal cancer surgery. J Gastrointest Oncol 2023; 14:1726-1734. [PMID: 37720453 PMCID: PMC10502545 DOI: 10.21037/jgo-22-1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/21/2023] [Indexed: 09/19/2023] Open
Abstract
Background Colorectal surgery in octogenarians is increasing in prevalence and good surgical outcomes have been demonstrated. However, functional status and independence remain the main patient consideration with limited data on the long-term functional outcomes. Methods A retrospective analysis was conducted for all patients aged above 80 undergoing surgery for colorectal cancer (CRC) from January 2018 to December 2019. Functional status assessment was made as part of pre- and post-operative allied health clinic appointments. Eastern Cooperative Oncology Group (ECOG) performance scores were recorded. Loss of independence (LOI) was defined as the reduced capacity to perform pre-morbid activities of daily living (ADL) and requiring increased supports. Results Forty-one patients aged 80 years or older had elective CRC resections with a median follow-up of 15 months [interquartile range (IQR): 8-20]. The median American Society of Anesthesiology (ASA) score was 3 and 90.2% (37/41) of patients had an ECOG score of 0 or 1. There was no 30-day mortality and 2 (4.9%) deaths occurred within 1 year. The median Clavien-Dindo score was 1, and 2 patients (4.9%) required unplanned intensive care unit (ICU) admissions. Twelve re-hospitalizations occurred with falls being the most common reason. LOI occurred in only 2 patients (4.9%) and on multivariate regression analysis, age and pre-morbid requirement of gait aids were predictive of LOI (P=0.042 and P=0.003, respectively). Gait aids were also associated with higher Clavien-Dindo scores (P=0.057) and increased length of stay (LOS) (P=0.009). Conclusions Patients with advanced age undergoing surgery for CRC surgery can still have good post-operative outcomes and adequate functional recovery with pre-operative optimization and appropriate post-operative supports.
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Affiliation(s)
- Kaushik Thungathurthi
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Matthew Wei
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Bushra Othman
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Anshini Jain
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Peter Girdlestone
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
| | - Raaj Chandra
- Colorectal Surgery, Division of General Surgery, Eastern Health, Melbourne, VIC, Australia
- Colorectal Surgery, Division of General Surgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Senior Adjunct Lecturer, Monash University, Melbourne, VIC, Australia
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Ma Q, Li H, Jiang Y, Wang Y, Liang J. Oncological and surgical outcomes of radical surgery in elderly colorectal cancer patients with intestinal obstruction. Front Surg 2023; 10:1251461. [PMID: 37675249 PMCID: PMC10477695 DOI: 10.3389/fsurg.2023.1251461] [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: 07/01/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background The treatment strategy for elderly colorectal cancer patients with intestinal obstruction remains controversial. The choice of reasonable treatment and surgical method directly affects perioperative safety and prognosis. This study investigated the safety and long-term efficacy of radical surgery in elderly colorectal cancer patients over 80 years old with intestinal obstruction. Methods The clinicopathological data of elderly patients over 80 years old with intestinal obstruction who underwent colorectal cancer surgery from January 2012 to December 2021 were retrospectively collected and analysed. Patients were assigned to a radical group and a palliative group according to the surgical method. Propensity score matching (PSM) was performed to match patients in the radical group 1:1 with those in the palliative group. The perioperative-related indexes and prognosis were compared between the two groups. Results A total of 187 patients were enrolled in this study. After PSM, 58 matched pairs were selected, and the radical and palliative groups were well balanced in terms of the clinical and surgical characteristics (P > 0.05). The proportion of patients transferred to the ICU after surgery in the radical group was significantly higher than that in the palliative group (17.2% vs. 5.2%, P = 0.039). In terms of postoperative complications, the incidence of grade 1-5 complications in the radical group was significantly higher than that in the palliative group (37.9% vs. 15.5%, P = 0.006); however, there was no significant difference in the incidence of grade 3-5 complications between the two groups (6.9% vs. 1.7%, P = 0.364). In addition, the complications were subclassified, and it was found that the incidence of gastrointestinal disorders (20.7% vs. 6.9%, P = 0.031) after surgery was significantly higher in the radical group. The 3-year OS rates were 55.2% and 22.6% in the radical and palliative groups, respectively (P < 0.001). Multivariate analysis revealed that radical surgery was an independent prognostic factor for OS (HR: 4.32; 95% CI, 1.93-12.45; P < 0.001). Conclusion Although elderly colorectal cancer patients over 80 years of age with intestinal obstruction are more likely to be admitted to the ICU and develop more postoperative complications after radical surgery, long-term survival benefits can be achieved.
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Affiliation(s)
- Qingbiao Ma
- Department of General Surgery, Liaoyang Central Hospital, Liaoyang, China
| | - Hongyu Li
- Department of General Surgery, Liaoyang Central Hospital, Liaoyang, China
| | - Yujuan Jiang
- Department 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, China
| | - Yingfei Wang
- Department of General Surgery, Liaoyang Central Hospital, Liaoyang, China
| | - Jianwei Liang
- Department 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, China
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Martínez-Escribano C, Arteaga Moreno F, Cuesta Peredo D, Blanco Gonzalez FJ, De la Cámara-de las Heras JM, Tarazona Santabalbina FJ. Before-and-After Study of the First Four Years of the Enhanced Recovery after Surgery (ERAS ®) Programme in Older Adults Undergoing Elective Colorectal Cancer Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15299. [PMID: 36430017 PMCID: PMC9691222 DOI: 10.3390/ijerph192215299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/05/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The aim of this study was to determine whether the inclusion of older patients undergoing elective colorectal cancer resection in the Enhanced Recovery After Surgery (ERAS®) programme could improve clinical outcomes during hospital admission. METHODS A before-and-after study in ≥70-year-old patients electively admitted for colorectal cancer resection was designed. In total, 213 patients were included in the ERAS® group, and 158 were included in the control group. RESULTS The average age was 77.9 years old (SD 5.31) and 57.14% of them were men, with a Charlson Index score of 3.42 (SD 3.32). The ERAS® group presented a lower transfusion rate of 42 (19.7%), compared to 75 (47.5%) in the control group (p < 0.001). The crude odds ratio (OR) for transfusion was 0.27 (95% CI 0.17-0.43; p < 0.001), and the adjusted odds ratio was 0.26 (95% CI 0.14-0.48; p < 0.001). The ERAS® group had a lower percentage of patients with moderate-severe malnutrition on admission, at 23.4% (37 patients) against 36.2% in the control group (42 patients) (p = 0.023), with an OR of 0.47 (95% CI 0.29-0.75; p < 0.002) and an adjusted OR of 0.48 (95% CI 0.29-0.78; p = 0.003). The number of patients who required admission to the intensive care unit (ICU) was also markedly lower: 54 from the ERAS® group (25.4%) versus 71 from the control group (44.9%) (p < 0.001). CONCLUSIONS The inclusion of ≥70-year-old adults in the ERAS® programme resulted in a decrease in transfusions, number of erythrocyte concentrates transfused, and number of ICU admissions, along with improved nutritional status.
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Affiliation(s)
- Cristina Martínez-Escribano
- Anaesthesiology, Resuscitation and Therapeutics of Pain, Hospital Universitario de la Ribera, Ctra de Corbera, km 1, 46600 Alzira, Valencia, Spain
- Medical School, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Valencia, Spain
| | - Francisco Arteaga Moreno
- Medical School, Universidad Católica de Valencia San Vicente Mártir, 46001 Valencia, Valencia, Spain
| | - David Cuesta Peredo
- Quality of Care Department, Hospital Universitario de la Ribera, 46600 Alzira, Valencia, Spain
| | | | | | - Francisco J. Tarazona Santabalbina
- Geriatric Medicine Department, Hospital Universitario de la Ribera, 46600 Alzira, Valencia, Spain
- Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable (CIBERFES), 28029 Madrid, Spain
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Damasceno AM, Kesley R, Paolino BS, Dos Santos do Amaral MR, Pitombo MB. Perioperative score for octogenarian patients eligible for rectal cancer surgery. J Surg Oncol 2021; 124:1409-1416. [PMID: 34363616 DOI: 10.1002/jso.26634] [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: 06/16/2021] [Revised: 07/08/2021] [Accepted: 07/29/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Colorectal cancer incidence increases with age; therefore, rectal cancer treatment in elderly patients is increasingly common. Surgery is a common rectal cancer treatment, and the risks involve complicated surgical decisions. There are currently few surgical outcome data for rectal cancer in elderly patients. The aim of this study is to identify new perioperative risk factors that could be associated with higher 30- and 180-day mortality in elderly patients in good clinical condition considering traditional perioperative risk scores and to develop a risk score. METHODS A single-centre, retrospective cohort study was performed by reviewing the medical records of patients from the National Cancer Institute of Brazil aged 80 years or older who electively underwent rectal cancer surgery; several independent variables correlated with death from all causes at 30 and 180 days were studied. RESULTS Multivariate analysis found new variables (CEA, albumin and reoperation) that had independent correlations with increased 30- and 180-day mortality. A clinical risk score was developed with survival profiles ranging from 29.3% to 97.2% within 30 days and 2.45% to 91.8% within 180 days. CONCLUSIONS This score can aid in deciding whether a patient should undergo rectal cancer surgery.
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Affiliation(s)
- Arthur Mota Damasceno
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rubens Kesley
- Department of Abdominal Surgery, National Cancer Institute of Brazil (INCA), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Souza Paolino
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Rubens Dos Santos do Amaral
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcos Bettini Pitombo
- Post-Graduate Program in Medical Sciences (PGCM), Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
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Impact of ASA-score, age and learning curve on early outcome in the initiation phase of an oncological robotic colorectal program. Sci Rep 2020; 10:15136. [PMID: 32934256 PMCID: PMC7493955 DOI: 10.1038/s41598-020-72025-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023] Open
Abstract
The ASA score is known to be an independent predictor of complications and mortality following colorectal surgery. We evaluated early outcome in the initiation phase of a robotic oncological colorectal resection program in dependence of comorbidity and learning curve. 43 consecutive colorectal cancer patients (median age: 74 years) who underwent robotic surgery were firstly analysed defined by physical status (group A = ASA1 + 2; group B = ASA3). Secondly, outcome was evaluated relating to surgery date (group E: early phase; group L: late phase). There were no differences among groups A and B with regard to gender, BMI, skin-to-skin operative times (STS), N- and M-status, hospital-stay as well as overall rate of complications according to Dindo-Clavien and no one-year mortality. GroupA when compared to group B demonstrated significantly lower mean age (65.5 years ± 11.4 years vs 75.8 years ± 8.9 years), T-stage and ICU-stay. When separately analyzed for patients age ICU-stay was comparable (> 75 years vs. < 75 years). Group E and L demonstrated comparable characteristics and early outcome except more frequent lymphatic fistulas in group E. STS was reduced in group L compared to group E. Beyond learning curve aspects in our series, we could demonstrate that patient’s physical condition according to ASA rather than age may have an impact on early outcome in the initial phase of a robotic oncological colorectal program.
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6
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Giarratano G, Shalaby M, Toscana C, Sileri P. Video-assisted anal fistula treatment for complex anal fistula: a long-term follow-up study. Colorectal Dis 2020; 22:939-944. [PMID: 32030874 DOI: 10.1111/codi.15005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
AIM This prospective study aimed to evaluate the safety and efficacy of video-assisted anal fistula treatment (VAAFT) in complex fistula-in-ano (FIA). METHOD Consecutive patients presenting with complex FIA were recruited between November 2012 and November 2018. The primary outcome was healing of the fistula. RESULTS Seventy-two patients were included, 39 (54%) of whom were men, with a mean age of 46 (±11) years. The mean follow-up was 32 (±18) months. Complete healing was achieved in 64 (89%) patients. When persistent and recurrent cases were considered together, the failure rate was 21% and the success rate 79%. When patients failed, they were offered VAAFT again, after which there was an in increase in the healing rate, which overall (primary and secondary) was 86%. There was no statistically significant deterioration in continence. Eight (11%) patients experienced postoperative complications which required no additional surgical intervention. CONCLUSION VAAFT represents a promising, sphincter-saving technique for the treatment of complex FIA. It has proved efficacious, with 79% of patients achieving complete healing after its primary application. After a second use, this reached 86%. The main advantage of VAAFT compared with other sphincter-saving techniques is working under direct vision. VAAFT has a good safety profile with 11% of patients experiencing minor complications, and there is no effect on continence.
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Affiliation(s)
- G Giarratano
- Department of General Surgery, Casa di Cura Nuova Itor, Rome, Italy.,Department of General Surgery, University of Rome Tor Vergata, Rome, Italy
| | - M Shalaby
- Department of General Surgery, Mansoura University, Mansoura, Egypt.,Department of General Surgery UOC C, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - C Toscana
- Department of General Surgery, Casa di Cura Nuova Itor, Rome, Italy
| | - P Sileri
- Department of General Surgery, University of Rome Tor Vergata, Rome, Italy.,Department of General Surgery UOC C, Policlinico Tor Vergata University Hospital, Rome, Italy
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7
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Zhao X, Yang Y, Gu H, Zhou W, Zhang Q. New prognostic risk score for predicting in-hospital mortality in geriatric patients undergoing colorectal cancer surgery: U.S. Nationwide Inpatient Sample analysis. J Geriatr Oncol 2020; 11:1250-1254. [PMID: 32376233 DOI: 10.1016/j.jgo.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/21/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To develop a new prognostic risk score index for predicting in-hospital mortality in geriatric patients undergoing colorectal cancer resection. PARTICIPANTS AND METHODS A retrospective study included 111,976 patients with colorectal cancer who were ≥ 65 years of age and underwent resection. The records were extracted from the Nationwide Inpatient Sample (NIS) database between 2005 and 2014. Univariate and multivariate analyses were conducted to determine the associations of in-hospital mortality and demographics, number of comorbidities, clinical and hospital-related characteristics. A prognostic risk score index on in-hospital mortality was established based on the odds ratios of the significant factors. RESULTS 30 points were distributed across the identified predictors of in-hospital mortality. Emergent admission had the greatest impact on mortality (adjusted OR = 3.01) and received the highest ranking with 7 points. The odds were followed by age ≥85 years old and number of comorbidities ≥3 (adjusted OR = 2.58 and 1.99, respectively), which received a rank of 5 points. The other elements of the risk score index were age 75-84 (4 points), male (3 points), tumor located in the colon or with distant metastasis (2 points), and with two comorbidities or socioeconomic status <Q4 (1 point). CONCLUSION This study proposes a novel risk score index for predicting in-hospital mortality in geriatric colorectal cancer patients undergoing resection. This risk score may be helpful for clinicians in decision-making and risk stratification at the pre-surgical phase.
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Affiliation(s)
- Xiaohong Zhao
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
| | - Yunmei Yang
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
| | - Haifeng Gu
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
| | - Wenjing Zhou
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
| | - Qin Zhang
- Department of Geriatrics, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang 310003, PR China.
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Carli F, Bessissow A, Awasthi R, Liberman S. Prehabilitation: finally utilizing frailty screening data. Eur J Surg Oncol 2020; 46:321-325. [PMID: 31954550 DOI: 10.1016/j.ejso.2020.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 12/06/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023] Open
Abstract
The elderly colorectal cancer patients tend to be frail, at nutrition risk with multiple comorbidities. In view of the stress on the body by surgery and recovery, it makes sense if patients are prepared before appropriately so that they can recover earlier and better. Prehabilitation prior to major surgery has attracted the attention of clinicians recently, and this review highlights the steps that need to be taken to implement a multidisciplinary program. Such programs requires a paradigm shift in the sense that all players need to be working in team for the benefit of patinets' outcome.
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Affiliation(s)
- Francesco Carli
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
| | - Amal Bessissow
- Department of Internal Medicine, McGill University, Montreal, Quebec, Canada
| | - Rashami Awasthi
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW Health-related quality of life (HRQoL) is a topic of great importance among older patients with cancer. Here we review the literature on HRQoL in older patients with colon and rectal cancer. RECENT FINDINGS HRQoL in older cancer patients with colon and rectal cancer can be impacted by care delivery model, use of selected treatments (i.e., chemotherapy), and the trajectory of the patient after surgery for colorectal cancer (CRC). HRQoL is an important outcome for older cancer patients. Greater numbers of older patients are undergoing treatment for CRC and may experience wide variations in quality of life during and after treatment. Trials should be developed with HRQoL as a primary outcome, and interventions need to be developed to maintain or improve HRQoL in older patients with cancer.
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Affiliation(s)
- Evan Lapinsky
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 925 Chestnut St., 4th Floor, Philadelphia, PA, 19107, USA
| | - Lillian C Man
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 925 Chestnut St., 4th Floor, Philadelphia, PA, 19107, USA
| | - Amy R MacKenzie
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 925 Chestnut St., 4th Floor, Philadelphia, PA, 19107, USA.
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Seow-En I, Tan WJ, Dorajoo SR, Soh SHL, Law YC, Park SY, Choi GS, Tan WS, Tang CL, Chew MH. Prediction of overall survival following colorectal cancer surgery in elderly patients. World J Gastrointest Surg 2019; 11:247-260. [PMID: 31171956 PMCID: PMC6536886 DOI: 10.4240/wjgs.v11.i5.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/09/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With advanced age and chronic illness, the life expectancy of a patient with colorectal cancer (CRC) becomes less dependent on the malignant disease and more on their pre-morbid condition. Justifying major surgery for these elderly patients can be challenging. An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.
AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.
METHODS In this retrospective cohort study, patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database. Patients with evidence of metastatic disease, and those who underwent emergency surgery or had surgery for benign colorectal conditions were excluded from the analysis. The primary outcome was overall 3-year overall survival (OS) following surgery. A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital, South Korea. Statistical analyses were performed using Stata/MP Version 15.1.
RESULTS A total of 1267 patients were identified for analysis. The median post-operative length of stay was 8 [interquartile range (IQR) 6-12] d and median follow-up duration was 47 (IQR 19-75) mo. Median OS was 78 (IQR 65-85) mo. Following multivariate analysis, the factors significant for predicting overall mortality were serum albumin < 35 g/dL, serum carcinoembryonic antigen ≥ 20 µg/L, T stage 3 or 4, moderate tumor cell differentiation or worse, mucinous histology, rectal tumors, and pre-existing chronic obstructive lung disease. Advanced age alone was not found to be significant. The Korean cohort consisted of 910 patients. The Singapore cohort exhibited a poorer OS, likely due to a higher proportion of advanced cancers. Despite the clinicopathologic differences, there was successful validation of the model following recalibration. An interactive online calculator was designed to facilitate post-operative survival prediction, available at http://bit.ly/sgh_crc. The main limitation of the study was selection bias, as patients who had undergone surgery would have tended to be physiologically fitter.
CONCLUSION This novel scoring system generates an individualized survival probability following colorectal resection and can assist in the decision-making process. Validation with an external population strengthens the generalizability of this model.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Winson Jianhong Tan
- Department of General Surgery, Sengkang General Hospital, Singapore 544886, Singapore
| | | | - Sharon Hui Ling Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Yi Chye Law
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu 702-210, South Korea
| | - Gyu-Seok Choi
- Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu 702-210, South Korea
| | - Wah Siew Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Choong Leong Tang
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Min Hoe Chew
- Department of General Surgery, Sengkang General Hospital, Singapore 544886, Singapore
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Kazama K, Aoyama T, Hayashi T, Yamada T, Numata M, Amano S, Kamiya M, Sato T, Yoshikawa T, Shiozawa M, Oshima T, Yukawa N, Rino Y, Masuda M. Evaluation of short-term outcomes of laparoscopic-assisted surgery for colorectal cancer in elderly patients aged over 75 years old: a multi-institutional study (YSURG1401). BMC Surg 2017; 17:29. [PMID: 28327119 PMCID: PMC5361779 DOI: 10.1186/s12893-017-0229-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/16/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The short-term outcomes of laparoscopic-assisted surgery for colorectal cancer (LAC) have not been fully evaluated in elderly patients. The aim of this study was to compare the short term surgical outcomes of LAC between the patients older than 75 years and those with non-elderly patients. METHODS This retrospective multi-institutional study selected patients who underwent LAC between April 2013 and March 2014 at Yokohama City University Hospital and its related general hospitals. The patients were categorized into two groups: elderly patients (>75 years of age: group A) and non-elderly patients (<75 years of age: group B). Surgical outcomes and post operative complications were compared between the two groups. RESULTS A total of 237 patients were evaluated in the present study. Eighty-four patients were classified into group A, and 153 into group B. Preoperative clinicopathological outcomes demonstrated no significant differences except for the ASA score. When comparing the surgical outcomes between group A and group B, the rate of conversion to open procedure (3.6% vs 5.2%, P = 0.750), median operation time (232 min vs 232 min, P = 0.320), median blood loss (20 ml vs 12 ml, P = 0.350). The differences were not significantly different in the surgical outcomes. The incidences of > grade 2 post operative surgical complications were similar between two groups ((19.0% vs 15.7%, p = 0.587). No mortality was observed in this study. The length of postoperative hospital stay was also similar (10 days vs 10 days, p = 0.350). CONCLUSIONS The present study suggested that LAC is safe and feasible, regardless of the age of the patient, especially for elderly patients who may be candidates for colon cancer surgery.
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Affiliation(s)
- Keisuke Kazama
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Tsutomu Hayashi
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takanobu Yamada
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shinya Amano
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Mariko Kamiya
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takaki Yoshikawa
- The Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, 241-8515, Japan
| | - Manabu Shiozawa
- The Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, 241-8515, Japan
| | - Takashi Oshima
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Kim BC. Colorectal Surgery in Elderly Patients. Ann Coloproctol 2016; 32:126-7. [PMID: 27626021 PMCID: PMC5019963 DOI: 10.3393/ac.2016.32.4.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Byung Chun Kim
- Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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