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Ilyas MIM. Epidemiology of Stage IV Colorectal Cancer: Trends in the Incidence, Prevalence, Age Distribution, and Impact on Life Span. Clin Colon Rectal Surg 2024; 37:57-61. [PMID: 38322602 PMCID: PMC10843881 DOI: 10.1055/s-0043-1761447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Colorectal cancer is a common malignancy in men and women. Historically, stage IV colorectal cancer has 10 to 15% five-year survival. Developments in the management of colorectal metastatic disease have helped improve the overall survival of stage IV colorectal cancers from 12 to 30 months with some patients achieving disease-free survival.
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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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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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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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Azher H, Beath A, Degabriele E, Faragher I, Chan STF, Yeung JM. Are health outcomes in the older colorectal cancer patients treated by curative intent surgery any different to the younger patients? ANZ J Surg 2022; 93:1185-1189. [DOI: 10.1111/ans.18188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/21/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Hinna Azher
- Department of Colorectal Surgery Western Health Melbourne Victoria Australia
| | - Alexander Beath
- Department of Colorectal Surgery Western Health Melbourne Victoria Australia
| | - Elizabeth Degabriele
- Department of Surgery, Western Precinct University of Melbourne Melbourne Victoria Australia
| | - Ian Faragher
- Department of Colorectal Surgery Western Health Melbourne Victoria Australia
| | - Steven T. F. Chan
- Department of Surgery, Western Precinct University of Melbourne Melbourne Victoria Australia
| | - Justin M. Yeung
- Department of Colorectal Surgery Western Health Melbourne Victoria Australia
- Department of Surgery, Western Precinct University of Melbourne Melbourne Victoria Australia
- Western Health Chronic Disease Alliance Western Health Melbourne Victoria Australia
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Current Treatment Approaches and Outcomes in the Management of Rectal Cancer Above the Age of 80. ACTA ACUST UNITED AC 2021; 28:1388-1401. [PMID: 33808512 PMCID: PMC8078162 DOI: 10.3390/curroncol28020132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 12/30/2022]
Abstract
Background: The number of cases of rectal cancer in our older cohort is expected to rise with our ageing population. In this study, we analysed patterns in treatment and the long-term outcomes of patients older than 80 years with rectal cancer across a health district. Methods: All cases of rectal cancer managed at the Illawarra Cancer Care Centre, Australia between 2006 and 2018 were analysed from a prospectively maintained database. Patients were stratified into three age groups: ≤65 years, 66–79 years and ≥80 years of age. The clinicopathological characteristics, operative and non-operative treatment approach and survival outcomes of the three groups were compared. Results: Six hundred and ninety-nine patients with rectal cancer were managed, of which 118 (17%) were aged 80 and above. Patients above 80 were less likely to undergo surgery (71% vs. 90%, p < 0.001) or receive adjuvant/neoadjuvant chemoradiotherapy (p < 0.05). Of those that underwent surgical resection, their tumours were on average larger (36.5 vs. 31.5 mm, p = 0.019) and 18 mm closer the anal verge (p = 0.001). On Kaplan–Meier analysis, those above 80 had poorer cancer-specific survival when compared to their younger counterparts (p = 0.032), but this difference was no longer apparent after the first year (p = 0.381). Conclusion: Patients above the age of 80 with rectal cancer exhibit poorer cancer-specific survival, which is accounted for in the first year after diagnosis. Priority should be made to optimise care during this period. There is a need for further research to establish the role of chemoradiotherapy in this population, which appears to be underutilised.
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Lee SM, Shin JS. Colorectal Cancer in Octogenarian and Nonagenarian Patients: Clinicopathological Features and Survivals. Ann Coloproctol 2020; 36:323-329. [PMID: 33207113 PMCID: PMC7714379 DOI: 10.3393/ac.2020.01.19.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/19/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Elderly population will comprise a substantial proportion of colorectal cancer (CRC) patients. We examined patients older than 80 years according to their clinical and pathological characteristics to fully understand the elderly patients. Methods CRC patients, 60 years or older at diagnosis, admitted between 2009 and 2014 at our hospital were enrolled. The patients were divided into 2 groups: elderly (aged > 80 years, n = 133), and controls (aged 60 to 79 years, n = 596). Patient’s demographics, risk factors for prognosis of CRC, Clinicopathological parameters, treatment, and survival rates were compared. Results The mean ages were 83.9 and 64.8 years, respectively. Male-to-female ratio and tumor sidedness were comparable in both groups. Prognostic factors found in univariate analysis; differentiation, stage, lymphovascular invasion, and carcinoembryonic antigen showed no statistical difference. The microsatellite instability status and number of retrieved lymph nodes were also similar (17.2 vs 21.6, P = 0.505). A significant difference was found in the treatment approach for chemotherapy as the elderly patients with stage III and IV tend to have omitted adjuvant (43.6% vs. 92.8%, P < 0.001) or palliative (35.8% vs. 89.4%, P = 0.016) chemotherapy. Except in stage I, elderly patients showed significantly lower overall survival rates. Conclusion Current study shows far-elderly patients with CRC were less likely to receive standard treatments, which might have resulted in an inferior outcome. As the number of elderly patients with CRC increase, our results provide a basis for further clinical and molecular investigations of elderly CRC patients.
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Affiliation(s)
- Soo Min Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Jun Sang Shin
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Jiménez I, Pacha MÁ, Pares D, Esteve M, Troya J, Roca J, Canet J, Julián JF, Fernández-Llamazares J. Survival and quality of life after surgery for colorectal cancer in the elderly: a comparative study. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 111:193-198. [PMID: 30545228 DOI: 10.17235/reed.2018.5807/2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND the aim of this study was to analyze the clinical results of the multidisciplinary management of elderly patients with colorectal cancer in a single center and to describe postoperative quality of life. METHODS a comparative study was designed to compare the results and quality of life of patients treated in our center for colon cancer, aged from 80 to 84 years (study group) compared to a control group (aged form 75 to 79 years of age). Morbidity, mortality, oncological results and quality of life were analyzed. RESULTS eighty-seven patients aged between 80 and 84 years of age (study group) were compared to a control group, which was formed by 91 patients aged from 75 to 79 years of age. There were no significant differences in technique and morbidity. Survival at 30 days, 90 days and at the end of follow-up (median 48 months) were similar in both groups. There were no differences in quality of life except for one item with regard to physical function (p = 0.0138). CONCLUSION similar clinical results and quality of life were achieved after treating elderly patients with colon cancer with a multidisciplinary management approach.
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Affiliation(s)
| | | | - David Pares
- Unidad de Cirugia Colorrectal, Hospital Germans Trias i Pujol. Universitat Autónoma de Barcelona, España
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Mothes H, Bauschke A, Schuele S, Eigendorff E, Altendorf-Hofmann A, Settmacher U. Surgery for colorectal cancer in elderly patients: how can we improve outcome? J Cancer Res Clin Oncol 2017; 143:1879-1889. [PMID: 28534171 DOI: 10.1007/s00432-017-2438-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/11/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Patients over 70 years of age are characterised by diminished long-term survival rates following resection of colorectal cancer (CRC) compared to younger patients. The aim of this study was to clarify whether reduced survival is a result of malignancy, comorbidities or the treatment received. METHODS All patients with CRC, who were admitted to our institution over a period of 10 years, were selected from a prospectively maintained database. Disease-specific, disease-free and overall survival rates were calculated dependent on variables considered potentially relevant for the patients' prognosis. RESULTS 915 patients were included in the study. Observed 5- and 10-year survival rates for the whole group were 48 ± 2% and 40 ± 2%, respectively, but 10-year survival rates dropped to 14 ± 4% for patients aged 80 and older. Resection of the primary tumour was attempted in all cases independent of age. Emergency admission, Charlson index ≥2, ECOG ≥2, old age, second malignancies, distant metastases, high grading and non-resective surgery were identified as independent prognostic parameters associated with decreased overall survival. In contrast, disease-specific and disease-free survival rates for patients after elective radical resection in UICC-stage I-III did not show significant differences related to age. Tumour site, UICC-stage and resection status were independent statistically significant predictors of disease-specific survival. CONCLUSIONS Similar disease-specific survival rates in all age groups speak in favour of tumour resection in curative intent even in old patients. Better outcome may be achieved, if regular screening for colorectal cancer is considered even in the elderly to avoid late presentation requiring emergency surgery.
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Affiliation(s)
- Henning Mothes
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Astrid Bauschke
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Silke Schuele
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ekkehard Eigendorff
- Department of Hematology and Oncology, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Annelore Altendorf-Hofmann
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
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