Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients
Background: The frailty of the very elderly patients who undergo surgery for colorectal cancer negatively influences postoperative mortality. This study aimed to identify risk factors for postoperative mortality in octogenarian and nonagenarian patients who underwent surgical treatment for colorecta...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-08-01
|
| Series: | Heliyon |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844019360232 |
| _version_ | 1818127825470750720 |
|---|---|
| author | Matteo Novello Francesco Vito Mandarino Salomone Di Saverio Davide Gori Marialuisa Lugaresi Alessandro Duchi Francesca Argento Giuseppe Cavallari James Wheeler Bruno Nardo |
| author_facet | Matteo Novello Francesco Vito Mandarino Salomone Di Saverio Davide Gori Marialuisa Lugaresi Alessandro Duchi Francesca Argento Giuseppe Cavallari James Wheeler Bruno Nardo |
| author_sort | Matteo Novello |
| collection | DOAJ |
| description | Background: The frailty of the very elderly patients who undergo surgery for colorectal cancer negatively influences postoperative mortality. This study aimed to identify risk factors for postoperative mortality in octogenarian and nonagenarian patients who underwent surgical treatment for colorectal cancer. Methods: This is a single institution retrospective study. The primary outcomes were risk factors for postoperative mortality. The variables of the octogenarians and nonagenarians were compared by using t-test, chi-square test, and Fisher exact test. A multivariate logistic regression analysis was carried out on the combined cohorts. Results: we identified 319 octogenarians and 43 nonagenarians (N = 362) who underwent surgery for colorectal cancer at the Sant’Orsola-Malpighi university hospital in Bologna between 2011 and 2015. The 30-day post-operative mortality was 6% (N = 18) among octogenarians and 21% (N = 9) for the nonagenarians.The groups significantly differed in the type of surgery (elective vs. urgent surgery, p < 0.0001), ASA score (p = 0.0003) and rates of 30-day postoperative mortality (6% vs. 21%, p = 0.0003).In the multivariate analysis ASA > III (OR 2.37, 95% CI [1.43–3.93], p < 0,001), and urgent surgery (OR 2.17, 95% CI [1.17–4.04], p = 0.014) were associated to post-operative mortality. On the contrary, pre-operative albumin≥3.4 g/dL (OR 0.14, 95% CI [0.05–0.52], p = 0.001) was associated with a protective effect on postoperative mortality. Conclusions: In the very elderly affected by colorectal cancer, preoperative nutritional status and pre-existing comorbidities, rather than age itself, should be considered as selection criteria for surgery. Preoperative improvement of nutritional status and ASA risk assessment may be beneficial for stratification of patients and ultimately for optimizing outcomes. |
| first_indexed | 2024-12-11T07:23:31Z |
| format | Article |
| id | doaj.art-7a599853bf354403994e3726be873c35 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-12-11T07:23:31Z |
| publishDate | 2019-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-7a599853bf354403994e3726be873c352022-12-22T01:16:02ZengElsevierHeliyon2405-84402019-08-0158e02363Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patientsMatteo Novello0Francesco Vito Mandarino1Salomone Di Saverio2Davide Gori3Marialuisa Lugaresi4Alessandro Duchi5Francesca Argento6Giuseppe Cavallari7James Wheeler8Bruno Nardo9Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola- Malpighi Hospital, University of Bologna, Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola- Malpighi Hospital, University of Bologna, Bologna, ItalyDepartment of Surgery, Carlo Alberto Pizzardi Maggiore Hospital, Largo Nigrisoli 2, Bologna, Italy; Colorectal Unit, Addenbrookes Hospital University of Cambridge, Cambridge, United Kingdom; Corresponding author.Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola- Malpighi Hospital, University of Bologna, Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola- Malpighi Hospital, University of Bologna, Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola- Malpighi Hospital, University of Bologna, Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola- Malpighi Hospital, University of Bologna, Bologna, ItalyDepartment of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola- Malpighi Hospital, University of Bologna, Bologna, ItalyBackground: The frailty of the very elderly patients who undergo surgery for colorectal cancer negatively influences postoperative mortality. This study aimed to identify risk factors for postoperative mortality in octogenarian and nonagenarian patients who underwent surgical treatment for colorectal cancer. Methods: This is a single institution retrospective study. The primary outcomes were risk factors for postoperative mortality. The variables of the octogenarians and nonagenarians were compared by using t-test, chi-square test, and Fisher exact test. A multivariate logistic regression analysis was carried out on the combined cohorts. Results: we identified 319 octogenarians and 43 nonagenarians (N = 362) who underwent surgery for colorectal cancer at the Sant’Orsola-Malpighi university hospital in Bologna between 2011 and 2015. The 30-day post-operative mortality was 6% (N = 18) among octogenarians and 21% (N = 9) for the nonagenarians.The groups significantly differed in the type of surgery (elective vs. urgent surgery, p < 0.0001), ASA score (p = 0.0003) and rates of 30-day postoperative mortality (6% vs. 21%, p = 0.0003).In the multivariate analysis ASA > III (OR 2.37, 95% CI [1.43–3.93], p < 0,001), and urgent surgery (OR 2.17, 95% CI [1.17–4.04], p = 0.014) were associated to post-operative mortality. On the contrary, pre-operative albumin≥3.4 g/dL (OR 0.14, 95% CI [0.05–0.52], p = 0.001) was associated with a protective effect on postoperative mortality. Conclusions: In the very elderly affected by colorectal cancer, preoperative nutritional status and pre-existing comorbidities, rather than age itself, should be considered as selection criteria for surgery. Preoperative improvement of nutritional status and ASA risk assessment may be beneficial for stratification of patients and ultimately for optimizing outcomes.http://www.sciencedirect.com/science/article/pii/S2405844019360232OncologyPathologyPublic healthSurgeryColorectal cancer surgeryPostoperative outcomes |
| spellingShingle | Matteo Novello Francesco Vito Mandarino Salomone Di Saverio Davide Gori Marialuisa Lugaresi Alessandro Duchi Francesca Argento Giuseppe Cavallari James Wheeler Bruno Nardo Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients Heliyon Oncology Pathology Public health Surgery Colorectal cancer surgery Postoperative outcomes |
| title | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
| title_full | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
| title_fullStr | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
| title_full_unstemmed | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
| title_short | Post-operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
| title_sort | post operative outcomes and predictors of mortality after colorectal cancer surgery in the very elderly patients |
| topic | Oncology Pathology Public health Surgery Colorectal cancer surgery Postoperative outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2405844019360232 |
| work_keys_str_mv | AT matteonovello postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT francescovitomandarino postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT salomonedisaverio postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT davidegori postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT marialuisalugaresi postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT alessandroduchi postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT francescaargento postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT giuseppecavallari postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT jameswheeler postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients AT brunonardo postoperativeoutcomesandpredictorsofmortalityaftercolorectalcancersurgeryintheveryelderlypatients |