Background: Colorectal cancer poses a major burden. Its incidence increases with age and older patients with comorbidities have a higher likelihood of major complications. This study investigated the impact of age on health outcomes in colorectal cancer patients treated by surgery. Methods: A prospective database of all patients undergoing colorectal cancer surgery with curative intent between 2012 and 2017 was used to identify patients. A retrospective review of existing medical records investigating health-related outcomes in colorectal cancer patients undergoing surgery was performed. Primary outcomes measured were overall survival (OS) and disease-free survival (DFS). Difference in restricted mean survival times (RMST) up to a pre-specified time point of 24 months was used to compare four age groups.Results: Six-hundred and fifty-one patients were divided into four age group categories: ≤65-years (n = 244), 66 to 75-years (n = 213), 76 to 85-years (n = 162) and >85-years (n = 32). Older patients were found to have a higher rate of post-operative medical complications (including confusion) (P = 0.001) and a longer length of stay (LOS) (P = 0.01). There was no difference between the 76 to 85-year age group and >85-year age group in OS and DFS. However, there was a reduced OS in older patients (>65) compared to their younger cohorts (<65) (P = 0.04). Conclusion: Older patients who undergo curative surgery have reduced OS, increased LOS and higher complication rates. Complex older patients may benefit from geriatric assessment and management in the peri-operative period.
Introduction: Neoadjuvant chemotherapy for pancreatic cancer is increasingly utilized. However, no guidelines exist for optimal adjuvant therapy after pancreatectomy with a partial or poor response to neoadjuvant therapy. This qualitative study seeks to describe our institution's patterns of adjuvant chemotherapy regimen selection after neoadjuvant therapy. Methods: All patients at a single institution from January 2013 through June 2019 receiving neoadjuvant chemotherapy followed by pancreatectomy for pancreatic cancer were reviewed. Patients enrolled in trials limiting chemotherapy or with missing medical oncology notes were excluded. Chemotherapy regimen, the College of American Pathologists pathologic tumor response, and medical oncology plans were recorded. Results: Fifty-three patients were reviewed and 41 patients met inclusion criteria. Neoadjuvant chemotherapy regimen are shown. Twenty-nine (70.7%) underwent pancreatoduodenectomy, 10 (24.3%) distal pancreatectomy, and 2 (4.8%) total pancreatectomy. Pathologic review of treatment effect demonstrated that 3 (7.3%) patients had complete pathologic response (cPR), 3 (7.3%) had near cPR, 16 (39%) had partial response, and 14 (34.1%) had poor/no response to neoadjuvant chemotherapy. Treatment effect was missing in 5 (12.2%) patients. Thirty-three (80.5%) patients received adjuvant chemotherapy, with 15 (45.5%) switching regimen adjuvantly. Pathology results guided therapy in 53.6% of patients and tumor response specifically guided therapy in 11 (30.5%) patients.
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