Impact of octogenarians on surgical outcome in colorectal cancer

Pirrera, Basilio; Vaccari, Samuele; Cuicchi, Dajana; Lecce, Ferdinando; Raffele, Emilio De; Via, Barbara Dalla; Laudo, Marco Di; Tonini, Valeria; Cervellera, Maurizio; Cola, Bruno

doi:10.1016/j.ijsu.2016.09.006

Cited by 26 publications

(27 citation statements)

References 21 publications

(17 reference statements)

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“…In fact, a higher but insignificant proportion of patients in the <75 group received emergency operation from symptoms of bowel obstruction or perforation (31.5% versus 12.9%, p=0.056). This finding is inconsistent with established consensus that the elderly population tends to present with symptoms requiring emergency surgical intervention (16,19). However, this may be a reflection of local demographics as seen in another UK-based and Swedish based study (17,20).…”

Section: Discussioncontrasting

confidence: 61%

“…Similarly, there were no differences in both the 30-day and 90-day postoperative mortality, p=0.269 and p=0.565 respectively, which was not observed before in previous literature (14,(16)(17)(18).…”

Section: Discussionsupporting

confidence: 58%

“…Overall, there were no difference of tumour staging in the elderly cohort, a finding which seems to be equivocal in current literature (15)(16)(17)(18)22,25) Cost effectiveness of CRC surgery in the elderly patients has been a rising topic for discussion. Govaert et al recently showed that hospital cost of CRC surgery is actually lower in patients aged ≥85, with the major driver of lower cost related to ward and ICU cost (26).…”

Section: Discussionmentioning

confidence: 83%

“…Past research has used arbitrary definitions varying from age 70 to 80 (13)(14)(15)(16)18,27), and this study has adopted an arbitrary cut-off of 75 years old. While having patients from a single tertiary center can standardise patient selection, it however provides only a very small cohort of patients and therefore limit generalisation of results.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Yen

Simillis

Choudhry

et al. 2017

Acta Chirurgica Belgica

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Yen

Simillis

Choudhry

et al. 2017

Acta Chirurgica Belgica

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“…Several recent studies have demonstrated similar postoperative outcomes in older adult patients compared with younger cohorts. [5][6][7][8][9] Specifically, whereas morbidity rates have been variably reported across age groups, similar postoperative mortality rates have been observed among older adult patients with pancreatic, 5 colon, 6 esophageal, 8 and hepatocellular carcinomas 7 compared with younger patient cohorts. In the context of these improved perioperative outcomes, it appears that age has become a less stringent selection criterion for patients undergoing major abdominal surgery.…”

Section: Introductionmentioning

confidence: 88%

Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

Neuwirth

Bierema

Sinnamon

et al. 2017

Cancer

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BACKGROUND:Although there is a general perception that, as the older population grows in number, more are undergoing surgery, there are few data on trends in major resections for cancer and short-term outcomes in this group. METHODS: The Nationwide Inpatient Sample was (NIS) used to estimate the national trends of major upper abdominal resections (esophagus, stomach, liver, pancreas) for cancer in octogenarians (aged 80 years) from 2001 to 2011. Resection rates performed per year were incidence-adjusted within this age group for each cancer type as determined by the NIS database. Joinpoint regression was used to calculate average annual percentage changes (AAPC) when evaluating trends over time. RESULTS: During the study period, octogenarians underwent an estimated 30,356 upper abdominal organ resections for cancer in the United States, representing 3.8% of all cancer admissions among octogenarians. Resection rates in octogenarians increased significantly over time (AAPC, 2.54; P < .001) secondary to increasing trends in pancreatic (AAPC, 11.52; P < .001) and hepatic (AAPC, 6.67; P < .001) resections. Elixhauser comorbidity index scores increased from a mean of 3.61 to 4.20 (AAPC, 1.31; P < .001), whereas inpatient mortality during this time decreased from 13.6% to 8.2% (AAPC, 5.58; P < .001). CONCLUSIONS: Overall rates of major upper abdominal cancer resections in octogenarians are increasing over time, driven by increases in liver and pancreatic resections. These increases were observed despite a less favorable patient morbidity profile over time. These patterns may suggest shifting selection criteria for octogenarians undergoing major abdominal surgery over time in the context of diminishing postoperative mortality. Cancer 2018;124:125-35. V C 2017 American Cancer Society.KEYWORDS: abdominal surgery, gastrointestinal cancer, national trends, octogenarian, outcomes. INTRODUCTIONOctogenarians (patients ages 80 years) have traditionally been considered at higher risk for major surgical procedures, including various types of cancer resections. This particular population is growing rapidly, with current forecasts estimating an increase in the population aged 85 years older from 1.7% of the population (5.4 million individuals) in 2008 to 7.5% of the population (projected, 27-35 million individuals) by 2050. 1 Likewise, it is estimated that adults aged 75 will increase from 18.7 million (6.1%) in 2010 to a projected 33.3 million (11%) by 2030. 2 The older population is also at the higher risk of developing cancer, with 60% of new diagnoses of malignancies occurring in those aged 65 years. 3,4 However, data reporting specific trends and outcomes in octogenarians with regard to major abdominal operations for cancer are relatively lacking. Characterization of such trends may be particularly important to help identify changes in selection criteria for surgery in this growing older adult population.Several recent studies have demonstrated similar postoperative outcomes in older adult patients compared with younger cohort...

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Multidimensional Prognostic Index (MPI) score has the major impact on outcome prediction in elderly surgical patients with colorectal cancer: The FRAGIS study

Pata

Bianchetti

Rota

et al. 2020

Journal of Surgical Oncology

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BackgroundThis study aims (I) to evaluate whether the Multidimensional Prognostic Index (MPI) score is associated with postoperative outcomes and (II) to develop a prognostic model for individual complication‐risk prediction following colorectal cancer (CRC) surgery.MethodThis is a prospective multicentric cohort study. Consecutive ≥75‐year‐old candidates for elective CRC surgery were enrolled from October 2017 to August 2019. Patients underwent standardized preoperative geriatric assessment including the MPI. Patients with MPI score > 0.33 were classified as frail. Logistic regression models were employed to evaluate variables associated with major postoperative complications and mortality, using 10‐fold cross‐validated LASSO (least absolute shrinkage and selection operator) for model selection.ResultsIn all, 104 patients were included, 34 (33%) had MPI score > 0.33. Major postoperative complications occurred in 52% of frail versus 16% of fit (MPI score ≤ 0.33) patients (p < .01). Both 30‐day (9% vs. 0%; p = .033) and 90‐day mortality (18% vs. 1%; p < .01) were higher among frail patients. In multivariate analysis, MPI score was associated with adverse outcomes. A final postoperative complication predictive model was created, including MPI score, gait‐speed test, ASA (American Society of Anesthesiology) score, surgical approach, and stoma creation.ConclusionMPI score is strongly associated with postoperative major complications in CRC elderly patients and it is a primary component of an individual prediction model.

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Impact of octogenarians on surgical outcome in colorectal cancer

Cited by 26 publications

References 21 publications

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

Multidimensional Prognostic Index (MPI) score has the major impact on outcome prediction in elderly surgical patients with colorectal cancer: The FRAGIS study

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