Results of surgical treatment of colorectal cancer in nonagenarian patients

The objective of the present study was to compare the results of surgical treatment of nonagenarian patients having colorectal cancer with patients younger than 90 years.

Methods:

A total of 622 patients who underwent curative surgery were included in the present study. The database of the surgical service, in the period from 2007 to 2013, was used to obtain the sample. This is a descriptive, retrospective study that compared the profiles of 17 nonagenarian patients (Group I) with 605 patients younger than 90 years (Group II). The groups were compared regarding surgical complications, length of hospital stay, type of surgery performed and ASA classification.

Results:

The mean age between the groups was 92.2 years and 61.2 years. The mean length of hospital stay in Groups I and II was 17.3 days and 8.75 days, respectively. The surgery performed most frequently was the right colectomy, in both groups. The most common postoperative complication was sepsis (11.8%) among the nonagenarians, and paralytic ileus (4.5%) among those younger than 90 years. Laparoscopic surgery was performed on 5 out of a total of 17 patients evaluated in Group I. Among the three mortalities registered in this latter group, two were classified as ASA III and only one as ASA I.

Conclusion:

The results indicate that colorectal surgery may be performed in this group, with acceptable morbidity and mortality rates, in patients with low preoperative risk (ASA I/II).

Keywords:
Colorectal cancer; Surgery; Nonagenarian; Morbidity; Mortality

Gender	<90 years n (%)	>90 years n (%)	p-value^a a Asymptotic Pearson Chi-squared test.
Female	314 (51.8)	10 (58.8)	0.568
Male	291 (48.2)	7 (41.2)
Total	605	17

	<90 years	>90 years
Mean ± SD	62.1 ± 13.2	92.2 ± 1.9
Median (Q1;Q3)	62.0 (53.0;72.5)	92.0 (91.0;93.5)

	<90 years	>90 years	p-value^a a Mann-Whitney test.
Mean ± SD	8.8 ± 10.6	16.7 ± 14.7	0.001
Median (Q1;Q3)	6.0 (5.0;9.0)	9.0 (7.0;27.0)

Group I	Conventional method	Laparascopic method	p-value^a a Mann-Whitney test.
Time (days)/patients	19.5 d/12 p	13 d/5 p	0.599
Median (Q1;Q3)	9.5 (7.0;28.3)	7.5 (6.0;22.5)
Mean ± SD	16.50 ± 16.55	12.00 ± 10.10

Complications	<90 years n (%)	>90 years n (%)	p-value^a a Z-test for comparison of proportions.	Clavien-Dindo^b b Clavien-Dindo classification of surgical complications.
Paralytic ileus	27 (4.5)	0 (0.0)	-
Sepsis	25 (4.1)	2 (11.8)^***	0.128	IVA
Wall abscess	17 (2.8)	1 (5.9)	0.456	IIIA
Anastomotic fistula	14 (2.3)	1 (5.9)	0.346	IVA
SRIS	10 (1.7)	0 (0.0)	-
Peritonitis	8 (1.3)	1 (5.9)	0.120	IVA
Neurogenic bladder	7 (1.1)	0 (0.0)	-
Pneumonia	6 (1.0)	1(5.9)	0.061	IVA
AMI	0 (0.0)	1 (5.9)	-	IVB
Ileostomy obstruction	0 (0.0)	1 (5.9)	-	IIIA
Hypertensive crisis	1 (0.2)	1 (5.9)	-
UTI	2 (0.4)	1 (5.9)	0.001
Others	61(10.1)	0 (0.0)	-
Presented complications	220 (36.3)	7 (35.2)	0.926

Clavien-Dindo	Group I	Group II	p-value^a a Z-test for comparison of proportions.
III	2/17 (11.76)	17/605 (2.81)	0.0344
IV	6/17 (35.29)	53/605 (8.76)	0.0002

	<90 years n (%)	≥90 years n (%)	p-value^a a Exact Pearson Chi-squared test.
I	290 (47.9)^*	4 (23.5)^*	0.013
II	259 (42.8)	7 (41.2)
III	51 (8.4)^*	5 (29.4)^*
IV	5 (0.8)^*	1 (5.9)^*

Index of complications	<90 years	>90 years	p-value^a a Z-test for comparison of proportions.
ASA I	74/605 (12.23)	1/17 (5.88)	0.428
ASA II	73/605 (12.07)	2/17 (11.76)	0.969
ASA III	14/605 (2.31)	3/17 (17.65)	0.0001
ASA IV	3/605 (0.50)	0 (0.00)	-

	<90 years n (%)	>90 years n (%)	p-value^a a Z-test for comparison of proportions.
Right colectomy	165 (27.1)	8 (47.1)	0.069
Left colectomy	83 (13.5)	2 (11.8)	0.833
Total colectomy	34 (5.4)	0 (0.0)	-
Partial colectomy	2 (0.3)	0 (0.0)	-
Total excision of the mesorectum	106 (17.3)	1 (5.9)	0.215
Upper anterior resection	84 (13.7)	1 (5.9)	0.352
Lower anterior resection	14 (2.1)	0 (0.0)	-
Anterior resection with stapler	43 (7.1)	1 (5.9)	0.847
Abdominoperineal amputation	32 (5.3)	0 (0.0)	-
Coloanal anastomosis	11 (1.8)	0 (0.0)	-
Ileostomy	3 (0.5)	0 (0.0)	-
Endoanal lowering	3 (0.5)	0 (0.0)	-
Others	25 (4.1)	4 (23.5)^b b Three Hartmann surgeries and a rectosigmoidectomy.	0.0002

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[1] *Corresponding author. E-mail: arthurmanoel_1@hotmail.com (A.M. Gomes).