Long-term outcomes in elderly patients after elective surgery for colorectal cancer within an ERAS protocol: a retrospective analysis

• Published in: Langenbeck's archives of surgery Vol. 408; no. 1; p. 438
• Main Authors: Navarra, Andrea, Porcellini, Iride, Mongelli, Francesco, Popeskou, Sotirios Georgios, Grass, Fabian, Christoforidis, Dimitri
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 17.11.2023
• Subjects: Abdominal Surgery; Aged; Aged, 80 and over; Brief Report; Cardiac Surgery; Colorectal Neoplasms - complications; Colorectal Neoplasms - surgery; Enhanced Recovery After Surgery; Female; General Surgery; Humans; Laparoscopy - methods; Length of Stay; Male; Medicine; Medicine & Public Health; Postoperative Complications - etiology; Retrospective Studies; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Long-term outcomes; Elderly; Colorectal surgery; Colorectal cancer; ERAS
• DOI: 10.1007/s00423-023-03179-7
• ISSN: 1435-2451

Purpose The number of elderly patients with a diagnosis of colorectal cancer (CRC) is increasing. Considering short life expectancy and multiple comorbidities, surgery may not always be the best treatment option. Methods We included all consecutive patients aged 80 years and older who underwent elective resection for CRC following Enhanced Recovery after Surgery (ERAS) protocol between January 2011 and May 2021. The primary endpoint was overall survival, secondary endpoints were 30-day morbidity, and the rate of return to pre-operative living conditions 3 months after surgery. Results Ninety-four patients were included. Mean age was 84.6 ± 3.6 years, 49 patients (52%) were female. Most patients (77.6%) were ASA score ≥ 3. Laparoscopic resections were performed in 85 patients (90.4%), involving 69 (73.4%) colonic and 25 (26.6%) rectal resections. A stoma was constructed in 22 patients (23%), and reversed in 12 (54.5%). Twenty-two patients (23.4%) experienced a Clavien-Dindo ≥ 3 complication, and 2 patients (2.1%) died. The median length of hospital stay was 8 (interquartiles: 6–15) days. Sixty-six patients (70.2%) were discharged home directly and 26 (27.7%) to rehabilitation or postacute care institutes. At three months after surgery, eighty-two patients (96.5%) returned to their pre-operative living conditions directly or after short-term rehabilitation. Mean follow-up was 53 ± 33 months, estimated 5-year overall survival was 60.3% (95%CI 49.5–71.1%), and disease-free survival was 86.3% (95%CI 78.1–94.4%). Conclusions Our study suggests that elderly patients undergoing elective surgery have a high potential to return to preoperative living conditions and good overall- and disease-free survivals, despite significant postoperative morbidity.