Introduction: Today average life expectancy in Western Countries has reached 80 years. At the same time, colorectal cancer (CRC) 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 this population should be offered life-prolonging radical surgeries. The aim of the study is to assess clinical features and postoperative outcomes in 80 years old and older patients treated for CRC. We focused on safety (complication rates and operative mortality) and oncological results (radical excision and number of isolated lymph nodes). Methods: From September 2011 to May 2015, 455 resections for CRC with curative intent were performed: 148 patients were over 80 years old (GroupA), 307 patients were younger than 80 years (GroupB). Patients’ demographic, clinical and histo-pathological parameters, as well as intra- and perioperative results were analysed. Results: In GroupA 72 patients underwent emergency procedures (49%) and 76 underwent elective procedures (51%); conversely in GroupB 85 patients underwent emergency procedures (53%) and 76 underwent elective procedures (47%), respectively (p<0.001). Significant differences between the two groups were observed regarding comorbidities, cardio-vascular comorbidities and chronic renal failure in particular, emergency presentation, intraoperative blood transfusions, laparoscopic approach 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, old age, emergency presentation (EP) and intraoperative blood transfusions are predictive of mortality; instead the presence of cardio-vascular comorbidities and EP, are independent predictor factors of morbidity. Conclusion: Old age (≥80) as such does not represent a contraindication for CRC surgical treatment though associated with an increased risk of postoperative morbidity and mortality, above on emergency procedures In our opinion it is advisable to reduce emergency procedures with multidisciplinary methods such as stenting in CRC obstruction as a bridge to surgery.
EMERGENCY COLO-RECTAL SURGERY IN PATIENTS OVER EIGHTY.
VACCARI, SAMUELE;MONARI, FRANCESCO;PIRRERA, BASILIO;PICARIELLO, ERIKA;USSIA, ALESSANDRO;CERVELLERA, MAURIZIO;TONINI, VALERIA
2015
Abstract
Introduction: Today average life expectancy in Western Countries has reached 80 years. At the same time, colorectal cancer (CRC) 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 this population should be offered life-prolonging radical surgeries. The aim of the study is to assess clinical features and postoperative outcomes in 80 years old and older patients treated for CRC. We focused on safety (complication rates and operative mortality) and oncological results (radical excision and number of isolated lymph nodes). Methods: From September 2011 to May 2015, 455 resections for CRC with curative intent were performed: 148 patients were over 80 years old (GroupA), 307 patients were younger than 80 years (GroupB). Patients’ demographic, clinical and histo-pathological parameters, as well as intra- and perioperative results were analysed. Results: In GroupA 72 patients underwent emergency procedures (49%) and 76 underwent elective procedures (51%); conversely in GroupB 85 patients underwent emergency procedures (53%) and 76 underwent elective procedures (47%), respectively (p<0.001). Significant differences between the two groups were observed regarding comorbidities, cardio-vascular comorbidities and chronic renal failure in particular, emergency presentation, intraoperative blood transfusions, laparoscopic approach 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, old age, emergency presentation (EP) and intraoperative blood transfusions are predictive of mortality; instead the presence of cardio-vascular comorbidities and EP, are independent predictor factors of morbidity. Conclusion: Old age (≥80) as such does not represent a contraindication for CRC surgical treatment though associated with an increased risk of postoperative morbidity and mortality, above on emergency procedures In our opinion it is advisable to reduce emergency procedures with multidisciplinary methods such as stenting in CRC obstruction as a bridge to surgery.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
