Background: Today average life expectancy in Western Countries has reached 80 years. At the same time, colorectal cancer (CCR) ranks first on both cancer incidence and related mortality. Therefore we face the problem of treating colorectal cancer occurring in elderly patients. Over the last years, there has been growing evidence in the literature that to this population should be offered life-prolonging radical surgeries. The aim of this study is to assess the clinical features and postoperative outcomes in 80 years old and older patients treated for colorectal cancer. We focused on safety (complication rates and operative mortality) and oncological results (radical excision and number of lymph nodes isolated). Methods: From September 2011 to May 2015, 483 resections for CCR with curative intent were performed; 16 explorative laparotomy and 12 trans-anal resection were excluded. Four hundred and fifty-five patients were enrolled: 307 of them were younger than 80 years and 168 patients were 80 years old or older. Patients’ demographic, clinical and histopathological parameters, as well as intra- and perioperative results were analysed. Statistical analysis was performed with SPSS v13.0; significance was defined as p < 0.05. Results: Significant differences between the two groups were observed regarding comorbidities (p<0.001), cardio-vascular comorbidities and chronic renal failure in particular, emergency presentation (p<0.001), intraoperative blood transfusions (p=0.015), laparoscopic approach (p=0.002) and mortality (p<0.001). No differences were observed between the two groups regarding the number of radical resection and number of lymph nodes isolated. However, multivariate logistic regression analysis showed that advanced geriatric age (≥80 years old) is an independent predictor of mortality (p=0.003 OR 4.756) but not an independent predictor of morbidity (p=0.669 OR 1.109); in particular, advanced geriatric age, emergency presentation and intraoperative blood transfusions are predictive of mortality; instead the presence of cardio-vascular comorbidities and emergency presentation, are independent predictor factors of morbidity. Conclusion: Old age (≥80) as such does not represent a contraindication for CCR surgical treatment though associated with an increased risk of postoperative morbidity and mortality. In our opinion, patients who are appropriately evaluated and selected might have a favourable prognosis after undergoing colorectal resection.

EMERGENCY COLO-RECTAL SURGERY IN PATIENTS OVER EIGHTY.

VACCARI, SAMUELE;MONARI, FRANCESCO;PIRRERA, BASILIO;PICARIELLO, ERIKA;USSIA, ALESSANDRO;CERVELLERA, MAURIZIO;TONINI, VALERIA
2015

Abstract

Background: Today average life expectancy in Western Countries has reached 80 years. At the same time, colorectal cancer (CCR) ranks first on both cancer incidence and related mortality. Therefore we face the problem of treating colorectal cancer occurring in elderly patients. Over the last years, there has been growing evidence in the literature that to this population should be offered life-prolonging radical surgeries. The aim of this study is to assess the clinical features and postoperative outcomes in 80 years old and older patients treated for colorectal cancer. We focused on safety (complication rates and operative mortality) and oncological results (radical excision and number of lymph nodes isolated). Methods: From September 2011 to May 2015, 483 resections for CCR with curative intent were performed; 16 explorative laparotomy and 12 trans-anal resection were excluded. Four hundred and fifty-five patients were enrolled: 307 of them were younger than 80 years and 168 patients were 80 years old or older. Patients’ demographic, clinical and histopathological parameters, as well as intra- and perioperative results were analysed. Statistical analysis was performed with SPSS v13.0; significance was defined as p < 0.05. Results: Significant differences between the two groups were observed regarding comorbidities (p<0.001), cardio-vascular comorbidities and chronic renal failure in particular, emergency presentation (p<0.001), intraoperative blood transfusions (p=0.015), laparoscopic approach (p=0.002) and mortality (p<0.001). No differences were observed between the two groups regarding the number of radical resection and number of lymph nodes isolated. However, multivariate logistic regression analysis showed that advanced geriatric age (≥80 years old) is an independent predictor of mortality (p=0.003 OR 4.756) but not an independent predictor of morbidity (p=0.669 OR 1.109); in particular, advanced geriatric age, emergency presentation and intraoperative blood transfusions are predictive of mortality; instead the presence of cardio-vascular comorbidities and emergency presentation, are independent predictor factors of morbidity. Conclusion: Old age (≥80) as such does not represent a contraindication for CCR surgical treatment though associated with an increased risk of postoperative morbidity and mortality. In our opinion, patients who are appropriately evaluated and selected might have a favourable prognosis after undergoing colorectal resection.
Vaccari, Samuele; Monari, Francesco; Pirrera, Basilio; Picariello, Erika; Alessandro, Ussia; Versari, Gianni; Governatore, Marco Del; Gaudio, Giovanni-Alberto Del; Cervellera, Maurizio; Tonini, Valeria .
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/592402
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