Operative mortality rate and surgery for colorectal cancer

Brown, Stephanie; Walsh, S.; Sykes, P A

doi:10.1002/bjs.1800750708

Cited by 40 publications

(38 citation statements)

References 12 publications

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“…The gap that has separated younger from elderly patients is closing. Although there have been recent reports from hospital series to the same effect (Bader, 1986;Kirtland and Hobler, 1986;Payne et al, 1986;Waldron et al, 1986;Irvin, 1988;Lewis and Khoury, 1988;Fielding et al, 1989;Ozoux et al, 1990;Arnaud et al, 1991), often indicating more optimistic figures (Brown et al, 1988), these reports are limited by unavoidable selection bias, especially for elderly patients. A community-based cancer registry has the advantage of providing a non-biased and detailed view of time trends in the management of cancer, without the limitations due to recruitment, which often varies with time.…”

Section: Discussionmentioning

confidence: 99%

Colon cancer in the elderly: evidence for major improvements in health care and survival

Arveux

Boutron²,

Mrini³

et al. 1997

Br J Cancer

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Summary Time trends in therapeutic approaches and in the prognosis of colon cancer for patients aged 75 years and above have been investigated in comparison with corresponding trends for younger patients using a population-based series of 2089 colon cancer patients diagnosed between 1976 and 1990 in the C6te-d'Or area (478 000 inhabitants), Burgundy, France. Significant progress has been achieved in the management of patients with colon cancer in both age groups, but trends have been more noticeable in patients aged 75 years and above. In the elderly, the proportion of cancers limited to the digestive tract wall showed a 3-year average increase of 2.8% (P = 0.02) and the frequency of curative surgery an average increase of 8.6% (P < 0.001), so that it was performed in 80% of cases in the last 3-year period. Operative mortality decreased by 2.5% between 3-year periods (P < 0.004). Crude 5-year survival rates in elderly patients increased from 15% in the 1976-78 period to 29% in the 1985-87 period (P < 0.001), the corresponding figures being 36% and 44% (P > 0.10) in younger patients.Keywords: colon cancer; stage at diagnosis; time trends; survival Colon cancer is a major problem in elderly patients. Incidence rates rise with age, and over 40% of cases occur in subjects over the age of 74. Recent studies have demonstrated an increase in the incidence of colon cancer in several areas of the Western world (Coleman et al, 1993) and, given the increasing life expectancy of Western populations, an ever-growing number of aged people is exposed to the risk of colon cancer. Age has often been considered as a negative factor in the prognosis for this cancer. However, raw survival data, from which such conclusions are usually drawn, overestimate mortality due to the malignancy under investigation, especially in elderly patients, for whom mortality owing to other causes is high, and tend to conceal the progress that has been achieved in the perioperative management of elderly patients over the past 15 years (Pillon et al, 1991). Data on therapeutic approaches and on the prognosis of colon cancer patients have mostly been provided by specialized hospital units, with unavoidable selection bias, especially for elderly patients. Outcome measuresThe spread of each malignancy at the time of diagnosis was classified, for resected cancers, according to Dukes (1932), as: limited to the digestive wall (Dukes A) (I, see tables); extension beyond the digestive wall (Dukes B) (II); and lymph node involvement (Dukes C) (Ill). In the absence of resection, cancers were classified as either metastatic (IV) or of undetermined stage (i.e. absence of detectable metastasis) (V). Treatment procedures were defined as: surgery for cure, i.e. complete tumour removal with tumour-free margins (1); palliative resection (II); palliative surgery with no tumour resection (i.e. colostomy or explorative laparotomy) (III); and medical treatment without surgery, i.e. chemotherapy, radiotherapy or purely palliative treatment (IV). As the impact of age and oth...

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Section: Discussionmentioning

confidence: 99%

Colon cancer in the elderly: evidence for major improvements in health care and survival

Arveux

Boutron²,

Mrini³

et al. 1997

Br J Cancer

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“…Weight loss and obstructive conditions were perceived to negatively impact short-term outcomes, as well as a number of medical conditions such as cardiovascular, pulmonary, renal, hepatic, and metabolic conditions [8][9][10][11].…”

Section: Comprehensive Geriatric Assessmentmentioning

confidence: 99%

“…There is considerable evidence that this steadily expanding population receives substandard treatment when compared with younger age groups [4]. Possible explanations that have been suggested for this inequity in treatment include A) the perceived limitations to conventional treatments in the elderly [5,6]; B) concerns about attendant serious associated medical conditions [7,8], and C) a reluctance by clinicians to incorporate older patients either into clinical trials of novel agents or into existing screening programs [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Assessment of Surgical Risk in Oncogeriatric Patients

et al. 2005

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Cancer is a prevalent disease in our aging population; however, few oncologists are familiar with caring for oncogeriatric patients. Surgery is presently the treatment of choice for most solid tumors, but it is frequently delivered in a suboptimal way in this patient subsetting. Undertreatment is often justified with the concern of an unsustainable toxicity, while overtreatment can be related to the lack of knowledge in optimizing preoperative risk assessment. To draw new light on this issue, several surgeons presented their series, providing hard evidence that surgical options can be offered to the elderly with cancer, with only a limited postoperative mortality and morbidity. As it is likely that much of these data suffer from selection bias, we concentrated on Comprehensive Geriatric Assessment (CGA), which can add substantial information on the functional assessment of elderly cancer patients. A validated instrument such as the CGA allows a comparison of series, predicting short-term surgical outcomes more precisely, and offers appropriate information when consenting elderly patients. Preoperative Assessment of Cancer in the Elderly is a prospective international study conceived and launched to outline the fitness of elderly surgical patients with malignant tumors. This paper reports on preliminary results and analysis from the ongoing study. The Oncologist 2005;10:262-268

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“…However, during surgical management of CRC, it was reported from a series of 578 CRC patients that 260 (45%) had lost more than 3 kg in the preoperative period, although the duration of this was not specified (Brown et al, 1991). More recently, 66% of preoperative CRC patients were found to have lost weight, and weight loss >10% was reported in 20% of this patient group (Burden et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients

Burden

Hill²,

Shaffer

et al. 2011

J Human Nutrition Diet

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Background: Perioperative oral supplementation has been shown to reduce post‐operative complications. However, the use of preoperative standard oral supplements in a cohort of colorectal cancer patients has not been evaluated. The present study examined whether preoperative supplements are beneficial in this group. Methods: In a randomised controlled trial, patients were assigned to receive 400 mL of oral supplement and dietary advice or dietary advice alone. Primary outcome was the number of post‐operative complications. One hundred and twenty‐five patients were recruited (59 randomised to the intervention group and 66 to the control group) and nine were excluded. Results: In the intervention group, 24 (44%) patients had a complication compared to 26 (42%) in the control group (P = 0.780). In the intervention and control groups, there were eight (15%) and 16 (25%) surgical site infections, respectively (P = 0.140) and seven (13%) and 11 (17%) chest infections, respectively (P = 0.470). Subgroup analysis for hypothesis generation included 83 (71%) weight‐losing patients, where there was a significant reduction in surgical site infections using the Buzby definition (P = 0.034), although this was not the case for the Centre for Disease Control definition (P = 0.052). Conclusions: There was no evidence that preoperative supplements were beneficial in reducing the number of complications, although there may be some benefit for surgical site infections in selected weight‐losing preoperative patients.

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Operative mortality rate and surgery for colorectal cancer

Cited by 40 publications

References 12 publications

Colon cancer in the elderly: evidence for major improvements in health care and survival

Colon cancer in the elderly: evidence for major improvements in health care and survival

Preoperative Assessment of Surgical Risk in Oncogeriatric Patients

An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients

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