Outcomes of colorectal cancer surgery in nonagenarian patients: a multicenter retrospective study

Zeng, Weigen; Liu, Meng-Jia; Zhou, Zhixiang; Hu, Junjie; Wang, Zhenjun

doi:10.21037/jgo-21-324

Cited by 7 publications

(12 citation statements)

References 22 publications

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“…Moreover, age did not present any association with surgical site infection, anastomotic leak, or with reoperation rate. These findings are consistent with those obtained from other large series, where age was not predictive of in-hospital complications or mortality, suggesting that other conditions may impact more significantly in surgical outcomes [ 8 , 12 , 14 , 19 , 20 , 25 ]. Therefore, it would be more appropriate to consider a frailty index rather than age in preoperative decision-making.…”

Section: Discussionsupporting

confidence: 91%

“…Similarly, a recent meta-analysis concluded that pre-existing liver cirrhosis was associated with higher postoperative major complication and mortality rates following CRC surgery [27]. One reason for this could be that abnormal liver metabolism leads to hepatic coagulopathy, Laparoscopic surgery is safe in older patients, and moreover, postoperative complications including wound infection, ileus, and pneumonia are less frequent than in open surgery [8,12,18,19,28]. In the present series, laparoscopic approach was found to be independently associated with a lower postoperative complication rate.…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic surgery is safe in older patients, and moreover, postoperative complications including wound infection, ileus, and pneumonia are less frequent than in open surgery [ 8 , 12 , 18 , 19 , 28 ]. In the present series, laparoscopic approach was found to be independently associated with a lower postoperative complication rate.…”

Section: Discussionmentioning

confidence: 99%

“…Surgeons are therefore faced with difficult decisions when managing increasingly older patients. It is estimated that postoperative adverse outcomes in this patient subgroup could be substantial, ranging from 6 to 50% [7][8][9][10][11][12]. Higher postoperative mortality rates of up to 20% have also been reported in older patients, mainly during the first 30 days after surgery [4,5,9,[11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, age has not appeared as a factor increasing postoperative complications or mortality rate [12,14,[17][18][19][20][21]. Some authors have reported comorbidities as the strongest predictors of postoperative complications in aged patients [8]. Preoperative identification of predictors of surgical complications in older patients could be useful for implementing additional optimization bundles before major surgery.…”

Section: Introductionmentioning

confidence: 99%

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Short-term outcomes of colorectal cancer surgery in older patients: a novel nomogram predicting postoperative morbi-mortality

Moro‐Valdezate

Martín-Arévalo

Ferro-Echevarría

et al. 2022

Langenbecks Arch Surg

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Purpose To analyze short-term outcomes of curative-intent cancer surgery in all adult patients diagnosed with colorectal cancer undergoing surgery from January 2010 to December 2019 and determine risk factors for postoperative complications and mortality. Methods Retrospective study conducted at a single tertiary university institution. Patients were stratified by age into two groups: < 75 years and ≥ 75 years. Primary outcome was the influence of age on 30-day complications and mortality. Independent risk factors for postoperative adverse events or mortality were analyzed, and two novel nomograms were constructed. Results Of the 1486 patients included, 580 were older (≥ 75 years). Older subjects presented more comorbidities and tumors were located mainly in right colon (45.7%). After matching, no between-group differences in surgical postoperative complications were observed. The 30-day mortality rate was 5.3% for the older and 0.8% for the non-older group (p < 0.001). In multivariable analysis, the independent risk factors for postoperative complications were peripheral vascular disease, chronic pulmonary disease, severe liver disease, postoperative transfusion, and surgical approach. Independent risk factors for 30-day mortality were age ≥ 80 years, cerebrovascular disease, severe liver disease, and postoperative transfusion. The model was internally and externally validated, showing high accuracy. Conclusion Patients aged ≥ 75 years had similar postoperative complications but higher 30-day mortality than their younger counterparts. Patients with peripheral vascular disease, chronic pulmonary disease, or severe liver disease should be informed of higher postoperative complications. But patients aged ≥ 80 suffering cerebrovascular disease, severe liver disease, or needing postoperative transfusion should be warned of significantly increased risk of postoperative mortality.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Short-term outcomes of colorectal cancer surgery in older patients: a novel nomogram predicting postoperative morbi-mortality

Moro‐Valdezate

Martín-Arévalo

Ferro-Echevarría

et al. 2022

Langenbecks Arch Surg

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Elective colorectal cancer surgery in nonagenarians and postoperative outcomes

et al. 2023

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Safety and feasibility of colonoscopy in nonagenarians: A systematic review, meta‐analysis and meta‐regression analysis

Hajibandeh,

Regan

et al. 2024

Colorectal Disease

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AimThe aim of this work was to evaluate the safety and feasibility of performing colonoscopy in patients aged 90 years or over.MethodIn compliance with PRISMA statement standards, a systematic review of studies reporting the outcomes of colonoscopy in patients aged ≥90 years was conducted. A proportional meta‐analysis model was constructed to quantify the risk of outcomes and a direct comparison meta‐analysis model was constructed to compare outcomes between nonagenarians and patients aged between 50 and 89 years via random‐effects models.ResultsSeven studies enrolling 1304 patients (1342 colonoscopies) were included. Analyses showed that complications related to bowel preparation occurred in 0.7% (95% CI 0.1%–1.6%), procedural complications in 0.6% (0.00%–1.7%), 30‐day complications in 1.5% (0.6%–2.7%), procedural mortality in 0.3% (0.0%–1.1%) and 30‐day mortality in 1.1% (0.3%–2.2%). Adequate bowel preparation and colonoscopy completion were achieved in 81.3% (73.8%–87.9%) and 92.1% (86.7%–96.3%), respectively. No difference was found in bowel preparation‐related complications [risk difference (RD) 0.00, p = 0.78], procedural complications (RD 0.00, p = 0.60), 30‐day complications (RD 0.01, p = 0.20), procedural mortality (RD 0.00, p = 1.00) or 30‐day mortality (RD 0.01, p = 0.34) between nonagenarians and patients aged between 50 and 89 years. The colorectal cancer detection rate was 14.3% (9.8%–19.5%), resulting in therapeutic intervention in 65.9% (54.5%–76.6%).ConclusionsAlthough the evidence is limited to a selected group of nonagenarians, it may be fair to conclude that if a colonoscopy is indicated in a nonagenarian with good performance status (based on initial less‐invasive investigations), the level 2 evidence supports its safety and feasibility. Age on its own should not be a reason for failing to offer colonoscopy to a nonagenarian.

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Outcomes of colorectal cancer surgery in nonagenarian patients: a multicenter retrospective study

Cited by 7 publications

References 22 publications

Short-term outcomes of colorectal cancer surgery in older patients: a novel nomogram predicting postoperative morbi-mortality

Short-term outcomes of colorectal cancer surgery in older patients: a novel nomogram predicting postoperative morbi-mortality

Elective colorectal cancer surgery in nonagenarians and postoperative outcomes

Safety and feasibility of colonoscopy in nonagenarians: A systematic review, meta‐analysis and meta‐regression analysis

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