Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians

Abstract

PurposeTo identify the factors affecting 30-day postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians.MethodsBetween 2005 and 2014, a total of 204 consecutive patients aged ≥80 years who underwent major colorectal surgery were included.ResultsOne hundred patients were male (49%) and 52 patients had American Society of Anesthesiologists (ASA) score ≥3 (25%). Combined surgery was performed in 32 patients (16%). Postoperative complications within 30 days after surgery occurred in 54 patients (26%) and 30-day mortality occurred in five patients (2%). Independent risk factors affecting 30-day postoperative complications were older age (≥90 years, hazard ratio [HR] with 95% confidence interval [CI] =4.95 [1.69−14.47], P=0.004), an ASA score ≥3 (HR with 95% CI =4.19 [1.8−9.74], P=0.001), performance of combined surgery (HR with 95% CI =3.1 [1.13−8.46], P=0.028), lower hemoglobin level (<10 g/dL, HR with 95% CI =7.56 [3.07−18.63], P<0.001), and lower albumin level (<3.4 g/dL, HR with 95% CI =3.72 [1.43−9.69], P=0.007). An ASA score ≥3 (HR with 95% CI =2.72 [1.15−6.46], P=0.023), tumor-node-metastasis (TNM) stage IV (HR with 95% CI =3.47 [1.44−8.39], P=0.006), and occurrence of postoperative complications (HR with 95% CI =4.42 [1.39−14.09], P=0.012) were significant prognostic factors for 1-year mortality.ConclusionPatient-related factors (older age, higher ASA score, presence of anemia, and lower serum albumin) and procedure-related factors (performance of combined surgical procedure) increased postoperative complications. Avoidance of 30-day postoperative complications may decrease 1-year mortality.

Risk factors for early postoperative complications after D3 dissection for stage II or III colon cancer: Supplementary analysis of a multicenter randomized controlled trial in Japan (JCOG0404)

“…We did not include age as a risk factor because all patients were between 20 and 75 years old. The studies of Kim and Kim and Ragg et al, respectively, showed that age greater than 90 years old and age greater than 75 years old to be one risk factor for overall postoperative complications.…”

Risk Factors for Adverse Outcome for Elderly Patients undergoing Curative Oncological Resection for Gastrointestinal Malignancies

“…Of the two studies with 30-day mortality as an outcome, scoring ASA >2 was the only predictor that was significantly associated with increased 30-day mortality [22,26].…”

“…Compared to open surgery, laparoscopic surgery was well tolerated and found to be significantly protective, with patients half as likely to develop Clavien-Dindo II complications (OR: 0.49) [22]. Tan et al [20] showed similar results (OR: 0.625).…”

“…A haemoglobin level of less than 10 g/dl preoperatively (hazard ratio: 6.21-7.56) was shown to be predictive of a Clavien-Dindo complication [22]. On the contrary, a preoperative haemoglobin level of more than 10 g/dl was shown to be protective (OR: 0.84) [19].…”

“…Two studies [20,21] demonstrated that an ASA score >3 was not significantly predictive of complications as defined by the Clavien-Dindo I-IV complications; whereas, four other studies showed that having an ASA score >2 was predictive [22][23][24][25]. Of the two studies with 30-day mortality as an outcome, scoring ASA >2 was the only predictor that was significantly associated with increased 30-day mortality [22,26].…”