Outcomes of Elderly Patients Undergoing Emergency Surgery for Complicated Colorectal Cancer: A Retrospective Cohort Study

Abstract

OBJECTIVE: Colorectal cancer is one of the most frequent types of malignant neoplasms. Age is a risk factor for this disease, with 75% of cases diagnosed in patients older than 65 years. Complications such as obstruction, hemorrhage, and perforation are present in more than one-third of cases and require emergency treatment. We aim to analyze the profile of elderly patients undergoing surgery for complicated colorectal cancer, and to evaluate factors related to worse short-term prognosis. METHODS: A retrospective analysis of patients who underwent emergency surgical treatment for complicated colorectal cancer was performed. Demographics, clinical, radiological and histological data were collected. RESULTS: Sixty-seven patients were analyzed. The median age was 72 years, and almost half (46%) of the patients were female. Obstruction was the most prevalent complication at initial presentation (72%). The most common sites of neoplasia were the left and sigmoid colon in 22 patients (32.8%), and the right colon in 17 patients (25.4%). Resection was performed in 88% of cases, followed by primary anastomosis in almost half. The most frequent clinical stages were II (48%) and III (22%). Forty-three patients (65.7%) had some form of postoperative complication. Clavien-Dindo grades 1, 2, and 4, were the most frequent. Complete oncologic resection was observed in 80% of the cases. The thirty-day mortality rate was 10.4%. Advanced age was associated with worse morbidity and mortality. CONCLUSION: Elderly patients with complicated colorectal cancer undergoing emergency surgery have high morbidity and mortality rates. Advanced age is significantly associated with worse outcomes.

Obstruksiyona neden olmuş kolorektal kanserli yaşlı hastalarda acil cerrahi sonuçları: Tek merkez deneyimi

“…Co-morbidity rate in the geriatric group was 60.5% in accordance with the literature (8). Total mortality rate was compatible with the literature with 8.55% (10). Although the rate of patients with ASA 4-5 score was significantly higher in the elderly group, the mortality rate in elderly patients were not different from the young patients.…”

<p>Risk Factors for Lymph Node Metastasis and Survival Outcomes in Colorectal Neuroendocrine Tumors</p>

“…The reason for the poor prognosis in elderly patients may be that elderly patients have lower tolerance to surgical trauma and side effects of chemotherapy because of their weakened organ physiological functions, which leads to multiple complications. 41,42 Therefore, when we encounter elderly patients, minimally invasive therapies such as laparoscopic surgery could help reduce surgical trauma, and Chinese herbs can relieve and reduce the adverse events of chemotherapy. 43 For NETs in the colon, the recommended treatment varies among different guidelines, but surgical resection is generally recommended because of the greater likelihood of malignant behavior than with rectal NETs.…”

Perforated colorectal cancers; clinical outcomes of 18 patients who underwent emergency surgery

“…Even in cases with diffuse peritonitis, it was reported that primary anastomosis can be performed safely, and mortality and morbidity rates in cases with primary anastomosis do not differ greatly from multi-stage surgical procedures. However, the most important problem in these patients, whose general condition is very bad and systemic effects of intraabdominal infection are seen, is anastomosis leak [16]. Our approach in this regard has been to avoid primary anastomosis in patients with faecal peritonitis.…”