Outcomes of colorectal cancer surgery in the nonagenarians: 20-year result from a tertiary center

Abstract

BackgroundThere is a foreseeable trend that life expectancy is on the rise in many parts of the world. More and more patients will present with colorectal cancer at extreme old age and advanced age is a well-known risk factor for adverse outcomes after surgery. The aim of this study is to evaluate the outcomes of colorectal cancer surgery in patients aged 90 or above.MethodA retrospective analysis of consecutive patients aged 90 or above who underwent operations for colorectal cancer between January 1996 and December 2015 was performed. The primary outcomes were the complications rate, 30-day and 180-day mortality rates.ResultsA total of 57 patients were included in the analysis. The majority of them were women (64.9%). The median age was 92 years. Most of the surgery was of curative intent (77.2%), performed under elective setting (57.9%) and with open approach (78.9%). 36.8% of patients had postoperative complications, with pneumonia being the commonest. The 30-day and 180-day mortality rate was 7 and 31.6% respectively. History of ischemic heart disease and surgery under emergency setting were predictors of postoperative complications. Pneumonia, preoperative leukocytosis and Charlson comorbidity score ≥ 9 were predictors of 180-day mortality. The one and two-year survival rate for elective surgery was 69.7 and 54.5% respectively.ConclusionThe outcomes of colorectal cancer surgery for nonagenarians could be favorable in a selected group of patients. Future study on better risk profiling and ways to improve outcomes is warranted.

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

“…We found that pneumonia or respiratory failure was the first cause of death. Chan et al (11) also demonstrated that pneumonia with respiratory failure as the most common postoperative complication and the leading cause of mortality. Yap et al (14) reported that by incorporating a physician's input into the perioperative care, the 30-day mortality could be as low as 2.1%, patients in the study had a much lower (2%) incidence of pneumonia.…”

“…Data on the operative and oncologic outcomes of nonagenarians with CRC are scarce. Several retrospective studies with a small number of patients have reported that CRC surgery appeared to be safe for select patients aged ≥90 years, with acceptable morbidity and mortality, although the results were conflicting (10)(11)(12)(13)(14)(15). Therefore, we conducted a multicenter study with a larger number of patients aged ≥90 years, and investigated their operative and oncologic outcomes.…”

Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review

“…This category includes a total of 12 studies distributed in four subcategories: patient profiles, cancer management in nursing homes, oncological treatment outcomes, and shared medical decisions [ 17 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

“…It is known that certain treatments against cancer in frail patients can lead to functional decline and excess mortality [27][28][29][30]. However, there was no published study found on the outcomes and feasibility of chemotherapeutic treatment in nursing home residents, Cancer is a frequent cause of death in nursing homes [58,61,63], although death is more related to functional decline than to tumor cancer itself [62].…”

Surgical outcomes following colorectal cancer resections in patients aged 80 years and over: results from the Australia and New Zealand Binational Colorectal Cancer Audit

“…This is comparable to similar populations in the literature [18][19][20]. However, as there is some variation seen with the age of inclusion, those studies with a lower age of inclusion tend to have a lower mortality, for example, a 30-day mortality of 1% when the lower limit of inclusion was 70 years, 3% when it was 80 years TA B L E 1 Baseline, perioperative and pathological characteristics by age category in patients undergoing colon and rectal cancer resection (N, %, unless otherwise indicated) and up to 7% when it was 90 years [19,21,22]. Mortality rates are much higher with acute surgery: a 30-day mortality rate of 15% in patients aged 80 years and above presenting with malignant large bowel obstruction and 30% when all non-elective presentations were considered in the same age group [23,24].…”