Impact of age on outcome after colorectal cancer surgery in the elderly - a developing country perspective

Abstract

BackgroundColorectal cancer (CRC) is a major source of morbidity and mortality in the elderly population and surgery is often the only definitive management option. The suitability of surgical candidates based on age alone has traditionally been a source of controversy. Surgical resection may be considered detrimental in the elderly solely on the basis of advanced age. Based on recent evidence suggesting that age alone is not a predictor of outcomes, Western societies are increasingly performing definitive procedures on the elderly. Such evidence is not available from our region. We aimed to determine whether age has an independent effect on complications after surgery for colorectal cancer in our population.MethodsA retrospective review of all patients who underwent surgery for pathologically confirmed colorectal cancer at Aga Khan University Hospital, Karachi between January 1999 and December 2008 was conducted. Using a cut-off of 70 years, patients were divided into two groups. Patient demographics, tumor characteristics and postoperative complications and 30-day mortality were compared. Multivariate logistic regression analysis was performed with clinically relevant variables to determine whether age had an independent and significant association with the outcome.ResultsA total of 271 files were reviewed, of which 56 belonged to elderly patients (≥ 70 years). The gender ratio was equal in both groups. Elderly patients had a significantly higher comorbidity status, Charlson score and American society of anesthesiologists (ASA) class (all p < 0.001). Upon multivariate analysis, factors associated with more complications were ASA status (95% CI = 1.30-6.25), preoperative perforation (95% CI = 1.94-48.0) and rectal tumors (95% CI = 1.21-5.34). Old age was significantly associated with systemic complications upon univariate analysis (p = 0.05), however, this association vanished upon multivariate analysis (p = 0.36).ConclusionOlder patients have more co-morbid conditions and higher ASA scores, but increasing age itself is not independently associated with complications after surgery for CRC. Therefore patient selection should focus on the clinical status and ASA class of the patient rather than age.

Advantage of Laparoscopy Surgery for Elderly Colorectal Cancer Patients without Compromising Oncologic Outcome

“…Surgery remains the mainstay to cure CRC. However, some studies reported high mortality and morbidity in elderly patients undergoing open colorectal surgery [5,6]. A systematic review of 28 studies also presented that postoperative morbidity and mortality increased with age [7].…”

Causes of 30-day readmission after neurosurgery of the spine

“…8,19,24,30 Age is also positively associated with mortality and complication rates in spine surgery, 33 gastric bypass surgery, 23 as well as many other surgical procedures, 16,32,38 so it is not surprising that it is also associated with 30-day readmission. Older age has been associated with higher comorbidity status and higher ASA class, 20 which alone have been reported as significant predictors of surgery outcomes. Jansson et al 19 found that age as a predictor for readmission varied depending on the age of the patient, with the lowest risk between ages 50 and 69 years and elevated risk for all ages below and above.…”

A study of gastrointestinal tumors at kathmandu medical college teaching hospital

“…Colorectal carcinoma was found to be more common among the age group of 51-60 years which was similar to the findings of a study done by Shah S et al 14 It is a matter of great concern that out of all colorectal cancers, 22.6% cases were found below 40 years which was 28.77% in a study of Shah et al 14 Malignancy was found to be more prevalent among male with M: F ratio of 1.6:1. The finding of Kansakar et al 15 was found to be 4:3 however, it was found to be equal in as study done by Shah S et al 14 and Khan MR et al 16 Stomach was found to be the second most commonly involved site comprising 28.6% however it was only 19.2% and 15.9% in a study done by Mohammad AM et al 17 and Jose L et al 18 respectively. Gastric carcinoma was found to be slightly more prevalent among male with M: F ratio of 1.4:1 but it was found to be 3:1 in a study done by Mohammad AM et al 17 Regarding age involvement, the finding of Mohammad AM et al 17 is similar to our finding as Gastric carcinoma was found to be less prevalent below 50 years (13.6%).…”