Comprehensive multidisciplinary care program for elderly colorectal cancer patients: “From prehabilitation to independence”

Souwer, Esteban T.D.; Bastiaannet, E.; Bruijn, S. de; Breugom, A.J.; Bos, Frederiek van den; Portielje, Johanneke E.A.; Dekker, Jan Willem T.

doi:10.1016/j.ejso.2018.08.028

Cited by 38 publications

(40 citation statements)

References 35 publications

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“…Studies were analysed according to the type of prehabilitation intervention. Meta-analysis was performed using RevMan software (Review Manager version 5.3, 2014; The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) Barberan-Garcia et al 10 Boden et al 36 Dronkers et al 42 Carli et al 9 Dunne et al 43 Banerjee et al 25 Barberan-Garcia et al 10 Boden et al 36 Dronkers et al 42 Dunne et al 43 Soares et al 45 Banerjee et al 25 Barberan-Garcia et al 10 Boden et al 36 Dronkers et al 42 Dunne et al 43 Soares et al 45 Santa Mina et al 44 83 Bousquet-Dion et al 47 Gillis et al 26 Kaibori et al 28 Li et al 49 Mazzola et al 50 Minnella et al 29 Souwer et al 52 Bousquet-Dion et al 47 Chia et al 48 Gillis et al 26 Jensen et al 27 Kaibori et al 28 Li et al 49 Mazzola et al 50 Minnella et al 29 Nakajima et al 51 Souwer et al 52 3 where the number (greater than 3) and quality of studies permitted, if the 95 per cent c.i. overlapped and effect sizes were similar 24 .…”

Section: Discussionmentioning

confidence: 99%

“…Smedley et al 33 A Mantel-Haenszel random-effects model was used for meta-analysis; risk differences are shown with 95 per cent confidence intervals. studies) 9,10,25,36,[42][43][44][45][46] , multimodal (10 studies) [26][27][28][29][47][48][49][50][51][52] , nutrition only (7 studies) [30][31][32][33]40,41,53 , psychological only (2 studies) 34,35 , CGA with optimization only (4) 37,38,54,55 and smoking cessation only (1 study) 39 . Sample sizes ranged from 32 to 443 patients, with most having fewer than 100 patients in each arm; only four studies 36,37,54,55 had more than this, and were mostly non-randomized.…”

Section: (Group 2)mentioning

confidence: 99%

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Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis

et al. 2020

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Background: Prehabilitation has emerged as a strategy to prepare patients for elective abdominal cancer surgery with documented improvements in postoperative outcomes. The aim of this study was to assess the evidence for prehabilitation interventions of relevance to the older adult. Methods: Systematic searches were conducted using MEDLINE, Web of Science, Scopus, CINAHL and PsychINFO. Studies of preoperative intervention (prehabilitation) in patients undergoing abdominal cancer surgery reporting postoperative outcomes were included. Age limits were not set as preliminary searches revealed this would be too restrictive. Articles were screened and selected based on PRISMA guidelines, and assessment of bias was performed. Qualitative, quantitative and meta-analyses of data were conducted as appropriate. Results: Thirty-three studies (3962 patients) were included. Interventions included exercise, nutrition, psychological input, comprehensive geriatric assessment and optimization, smoking cessation and multimodal (two or more interventions). Nine studies purposely selected high-risk, frail or older patients. Thirty studies were at moderate or high risk of bias. Ten studies individually reported benefits in complication rates, with meta-analyses for overall complications demonstrating significant benefit: multimodal (risk difference −0⋅1 (95 per cent c.i. −0⋅18 to −0⋅02); P = 0⋅01, I 2 = 18 per cent) and nutrition (risk difference −0⋅18 (−0⋅26 to −0⋅10); P < 0⋅001, I 2 = 0 per cent). Seven studies reported reductions in length of hospital stay, with no differences on meta-analysis. Conclusion: The conclusions of this review are limited by the quality of the included studies, and the heterogeneity of interventions and outcome measures reported. Exercise, nutritional and multimodal prehabilitation may reduce morbidity after abdominal surgery, but data specific to older patients are sparse.

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Section: Discussionmentioning

confidence: 99%

Section: (Group 2)mentioning

confidence: 99%

Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis

et al. 2020

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“…Moving forward, screening for frailty could be incorporated in future preoperative anaesthetic optimisation process with the view of implementing prehabilitation regimens. Evidence exists that prehabilitation implemented in the elderly and frail improves postoperative outcomes [27].…”

Section: Resultsmentioning

confidence: 99%

Outcomes of the Extreme Elderly Undergoing Anaesthesia and Surgery amongst Southeast Asians

Lee

Thong

2020

Anesthesiology Research and Practice

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Introduction. With a rapidly ageing population in Singapore, we see an increasing number of elderly patients undergoing surgery, both elective and emergency. This study aims to look at the anaesthesia techniques employed in a subset of very elderly population undergoing surgery and their subsequent postoperative outcomes, in particular their 30-day mortality, postoperative complication rates, and length of hospital stays. Materials and Methods. We searched from our hospital records between 2012 and 2013 for patients equal to or older than 90 years old who have undergone surgery and retrospectively analysed the types of surgery and mode of anaesthesia used. Results. Sixty-two patients were identified. The mean age is 93.6 years. Majority were ASA 2 and ASA 3 patients. The most common type of surgery performed was orthopaedic, followed by vascular and urologic. Seven of the 62 patients required re-operations. Regional was the predominant anaesthetic technique employed, followed by general anaesthesia. Intraoperative hypotension was seen in 16 of the patients, all of whom recovered uneventfully. Hypothermia, desaturation, and hypertension were the top three complications observed in the recovery. Seventeen patients were admitted to a high-dependency facility postoperatively. The mean length of stay was 13.7 days. The 30-day mortality was 1.6 percent. Conclusions. We have provided a snapshot of very elderly patients coming for surgery. The results show that this group of elderly patients do well postoperatively with relatively low complication and 30-day mortality rates. The outcomes presented can be used as a guide for risk counseling in the perioperative period.

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“…A few previous studies have tried to elucidate causes of death within the first year after colorectal cancer surgery and found that most patients died directly or indirectly of colorectal cancer, except the elderly ≥ 75 years of age [32–35].…”

Section: Discussionmentioning

confidence: 99%

Screening and systematic follow-up for cardiopulmonary comorbidity in elective surgery for colorectal cancer: a randomised feasibility study

et al. 2019

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Background One third of patients with colorectal cancer (CRC) have comorbidity, which impairs their postoperative outcomes. Scoring systems may predict mortality, but there is limited evidence of effective interventions in high-risk patients. Our aim was to test a trial setup to assess the effect of extra postoperative medical visits and follow-up on 1-year mortality and other outcomes in patients with cardiopulmonary risk factors undergoing elective surgery for colorectal tumours. Methods Patients preoperatively screened positive for cardiopulmonary comorbidity were eligible. On postoperative day 4, they were randomised to either routine follow-up (RFU) or RFU with one extra medical visit and additional visits to the Cardiology and Respiratory Medicine Clinics 1 and 3 months postoperatively. The primary outcome measure was 1-year mortality; secondary outcome measures were length of stay (LOS), complications, and readmissions. Results Of 673 screened patients 326 (48%) were found eligible, 108 declined participation, and 198 were randomised. Postoperative medical problems and/or need for intervention were found in 15–23% of the patients at the extra medical visits. The 90-day mortality was 0 and the 1-year mortality only 2.6% with no differences between the two groups. LOS and complication rates did not differ, but there were significantly fewer readmissions in the intervention group. Conclusions The 1-year mortality after elective CRC surgery was low, even in the presence of cardiopulmonary risk factors. There was no evidence of reduced mortality with additional medical follow-up in these patients. Trial registration ClinicalTrials.gov NCT02328365 registered 31 December 2014 (retrospectively registered)

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Comprehensive multidisciplinary care program for elderly colorectal cancer patients: “From prehabilitation to independence”

Cited by 38 publications

References 35 publications

Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis

Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis

Outcomes of the Extreme Elderly Undergoing Anaesthesia and Surgery amongst Southeast Asians

Screening and systematic follow-up for cardiopulmonary comorbidity in elective surgery for colorectal cancer: a randomised feasibility study

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