Perioperative and oncologic outcomes in young and octogenarian patients with colorectal cancer: a comparison at the extremes
Introduction In colorectal cancer (CRC), surgical outcomes in the young (< 50) and octogenarian populations are believed to be poor due to an aggressive phenotype in the former, and increased frailty in the latter. Given that age-related effects are inversely related between groups, we compared s...
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Published in | Langenbeck's archives of surgery Vol. 406; no. 7; pp. 2399 - 2408 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
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Springer Berlin Heidelberg
01.11.2021
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Abstract | Introduction
In colorectal cancer (CRC), surgical outcomes in the young (< 50) and octogenarian populations are believed to be poor due to an aggressive phenotype in the former, and increased frailty in the latter. Given that age-related effects are inversely related between groups, we compared short- and long-term outcomes of young and octogenarian patients with CRC to determine the dominance of one age-related factor over another.
Methods
A prospectively collected database from 2015 to 2020 of all CRC was analyzed. Cases were divided into metastatic and non-metastatic groups.
Results
Among non-metastatic cases, there were 34 young and 113 octogenarian patients. Mean CEA was higher among octogenarians (11.2 vs 32.8 units/ml;
p
= 0.041). Octogenarians suffered from more comorbidities than younger counterparts, with increased rates of postoperative UTI (3.3% vs 10.3%;
p
= 0.246) and pneumonia (3.1% vs 8.8%;
p
= 0.331). There was no increased rate of reintervention or Clavien-Dindo scores. We noticed a statistically significant higher proportion of extramural vascular invasion (EMVI) (8.8% vs 32.3%;
p
= 0.003) among the young. When excluding octogenarians who had declined surgery, Kaplan–Meier analysis showed no difference in disease-free (
p
= 0.290) or overall survival (
p
= 0.111). Among metastatic cases, there were 21 young and 19 octogenarian patients. Young patients were treated more aggressively with chemotherapy (55.6% vs 12.5%;
p
= 0.040). There was however no difference in overall survival between groups (
p
= 0.610).
Conclusions
Octogenarians may have more comorbidities, but can achieve similar surgical outcomes with younger patients. There is no reason to suspect a more aggressive phenotype in younger patients. |
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AbstractList | INTRODUCTIONIn colorectal cancer (CRC), surgical outcomes in the young (< 50) and octogenarian populations are believed to be poor due to an aggressive phenotype in the former, and increased frailty in the latter. Given that age-related effects are inversely related between groups, we compared short- and long-term outcomes of young and octogenarian patients with CRC to determine the dominance of one age-related factor over another. METHODSA prospectively collected database from 2015 to 2020 of all CRC was analyzed. Cases were divided into metastatic and non-metastatic groups. RESULTSAmong non-metastatic cases, there were 34 young and 113 octogenarian patients. Mean CEA was higher among octogenarians (11.2 vs 32.8 units/ml; p = 0.041). Octogenarians suffered from more comorbidities than younger counterparts, with increased rates of postoperative UTI (3.3% vs 10.3%; p = 0.246) and pneumonia (3.1% vs 8.8%; p = 0.331). There was no increased rate of reintervention or Clavien-Dindo scores. We noticed a statistically significant higher proportion of extramural vascular invasion (EMVI) (8.8% vs 32.3%; p = 0.003) among the young. When excluding octogenarians who had declined surgery, Kaplan-Meier analysis showed no difference in disease-free (p = 0.290) or overall survival (p = 0.111). Among metastatic cases, there were 21 young and 19 octogenarian patients. Young patients were treated more aggressively with chemotherapy (55.6% vs 12.5%; p = 0.040). There was however no difference in overall survival between groups (p = 0.610). CONCLUSIONSOctogenarians may have more comorbidities, but can achieve similar surgical outcomes with younger patients. There is no reason to suspect a more aggressive phenotype in younger patients. Introduction In colorectal cancer (CRC), surgical outcomes in the young (< 50) and octogenarian populations are believed to be poor due to an aggressive phenotype in the former, and increased frailty in the latter. Given that age-related effects are inversely related between groups, we compared short- and long-term outcomes of young and octogenarian patients with CRC to determine the dominance of one age-related factor over another. Methods A prospectively collected database from 2015 to 2020 of all CRC was analyzed. Cases were divided into metastatic and non-metastatic groups. Results Among non-metastatic cases, there were 34 young and 113 octogenarian patients. Mean CEA was higher among octogenarians (11.2 vs 32.8 units/ml; p = 0.041). Octogenarians suffered from more comorbidities than younger counterparts, with increased rates of postoperative UTI (3.3% vs 10.3%; p = 0.246) and pneumonia (3.1% vs 8.8%; p = 0.331). There was no increased rate of reintervention or Clavien-Dindo scores. We noticed a statistically significant higher proportion of extramural vascular invasion (EMVI) (8.8% vs 32.3%; p = 0.003) among the young. When excluding octogenarians who had declined surgery, Kaplan–Meier analysis showed no difference in disease-free ( p = 0.290) or overall survival ( p = 0.111). Among metastatic cases, there were 21 young and 19 octogenarian patients. Young patients were treated more aggressively with chemotherapy (55.6% vs 12.5%; p = 0.040). There was however no difference in overall survival between groups ( p = 0.610). Conclusions Octogenarians may have more comorbidities, but can achieve similar surgical outcomes with younger patients. There is no reason to suspect a more aggressive phenotype in younger patients. |
Author | Chan, Dedrick Kok Hong Keh, Christopher Hang Liang Leong, Sze Wai |
Author_xml | – sequence: 1 givenname: Dedrick Kok Hong orcidid: 0000-0002-4237-8648 surname: Chan fullname: Chan, Dedrick Kok Hong email: dedrick_kh_chan@nuhs.edu.sg organization: Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore – sequence: 2 givenname: Sze Wai surname: Leong fullname: Leong, Sze Wai organization: Department of General Surgery, Ng Teng Fong General Hospital, National University Health System – sequence: 3 givenname: Christopher Hang Liang surname: Keh fullname: Keh, Christopher Hang Liang organization: Department of General Surgery, Ng Teng Fong General Hospital, National University Health System |
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Snippet | Introduction
In colorectal cancer (CRC), surgical outcomes in the young (< 50) and octogenarian populations are believed to be poor due to an aggressive... INTRODUCTIONIn colorectal cancer (CRC), surgical outcomes in the young (< 50) and octogenarian populations are believed to be poor due to an aggressive... |
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SubjectTerms | Abdominal Surgery Cardiac Surgery General Surgery Medicine Medicine & Public Health Original Article Thoracic Surgery Traumatic Surgery Vascular Surgery |
Title | Perioperative and oncologic outcomes in young and octogenarian patients with colorectal cancer: a comparison at the extremes |
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