Congestive heart failure and comorbidity as determinants of colorectal cancer perioperative outcomes

Abstract

There has been an increase in surgical interventions in frailer elderly with concomitant chronic diseases. The purpose of this paper was to evaluate the impact of aging and comorbidities on outcomes in patients who underwent surgery for the treatment of colorectal cancer (CRC) in Veneto Region (Northeastern Italy). This is a retrospective cohort study in patients ≥ 40 years who underwent elective or urgent CRC surgical resection between January 2013 and December 2015. Independent variables included: age, sex, and comorbidities. We analyzed variables associated with the surgical procedure, such as stoma creation, hospitalization during the year before the index surgery, the surgical approach used, the American Society of Anesthesiologists (ASA) score, and the Charlson Comorbidity Index score. Eight thousand four hundred and forty-seven patients with CRC underwent surgical resection. Patient age affected both pre- and post-resection LOS as well as the overall survival (OS); however, it did not affect the 30-day readmission and reoperation rates. Multivariate analysis showed that age represented a risk factor for longer preoperative and postoperative LOS as well as for 30-day and 365-day mortality, but it was not associated with an increased risk of 30-day reoperation and 30-day readmission. Chronic Heart Failure increased the 30-day mortality risk by four times, the preoperative LOS by 51%, and the postoperative LOS by 33%. Chronic renal failure was associated with a 74% higher 30-day readmission rate. Advanced age and comorbidities require a careful preoperative evaluation and appropriate perioperative management to improve surgical outcomes in older patients undergoing elective or urgent CRC resection.

Colorectal Cancer: Current Updates and Future Perspectives

“…Although mortality is decreasing in the majority of developed countries, the number of deaths is estimated to increase by 60.0% for colon cancer and 71.5% for rectal cancer until 2035 [ 54 ]. Nevertheless, it is important to underline the increase in surgical interventions in frailer elderly affected by concomitant chronic diseases [ 55 , 56 ].…”

Case Report: Abdominal surgery with the support of Impella (SURGELLA), a new frontier to be explored

“…Therefore, with a longer life expectancy and an aging population, the number of patients with CRC and cardiovascular comorbidities is expected to increase ( 2 ). In a recent study, chronic heart failure (HF) was shown to increase the risk of 30-day mortality by up to 4-fold in patients with CRC undergoing colon resection ( 3 ).…”