Results from a preliminary research study showed the majority of patients aged 85 years and older were still alive in the short-term after undergoing segmental colectomy for stage II and III colon cancer. Kaur et al presented these findings at the American College of Surgeons Clinical Congress 2019.
Methods
Using the New York State Cancer Registry and Statewide Planning Research & Cooperative System, lead study author Roma Kaur, MD, a research fellow in the Department of Surgery at the University of Rochester Medical Center, and colleagues analyzed data on 3,779 patients age 85 and older who underwent colectomy between 2004 and 2012. They looked at short-term outcomes (30- and 90-day) among patients with stage II and III colon cancer.
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“We were interested in this topic because we know from Centers for Disease Control and Prevention data that patients 85 and older have the highest incidence rate of colon cancer…according to the U.S. Census Bureau, this is the fastest-growing segment of the geriatric population. Given the burden of colon cancer in this cohort, we were hoping to identify and better understand factors that were associated with survival in these patients,” said Dr. Kaur.
Results
The survival rates of all patients were evaluated from the time of the operation. After 30 days, 89% of patients were alive, and after 90 days, 83% of patients were still alive. Factors associated with worse survival were surgery during an unplanned admission; having an open operation; and preoperative complications like perforation, bleeding, and sepsis. Nearly half of the patients received a diagnosis of colon cancer and had surgery performed during an unplanned hospital admission.
Regarding the number of nonelective procedures, Dr. Kaur said, “It seems a large number of patients are coming into the hospital with a problem that is severe enough to require admission—sometimes a complication from their cancer—and then getting diagnosed with cancer and undergoing an operation during that same hospitalization. We found that 80% [of patients] had an open operation, as opposed to a minimally invasive one, so these patients are being subjected to open operations because, in part, it's taking place in an acute setting.”
“When patients have surgery in a nonelective setting, it makes it nearly impossible for these patients to be adequately optimized before their operation. If we are able to find these patients earlier, we may be able to do a comprehensive geriatric assessment, prehabilitation before surgery, and perhaps even a minimally invasive operation,” she added.
Results from the study corroborate the idea that perhaps screening guidelines should not be solely based on chronological age, but rather be more individualized and incorporate the patient's life expectancy, health status, and ability to tolerate the screening procedure into account. The role of less invasive screening alternatives and identifying the “right” patients to screen will require further study, according to the researchers.
This study found that two factors—discharge to another health-care setting and higher surgeon colon cancer resection volume—were associated with improved survival.
About 42% of patients were discharged to a skilled nursing facility after their operation. The move reduced the odds of dying by 89% at 30 days and by 58% at 90 days.
The researchers reported a nearly 59% reduction in the odds of mortality in the short-term associated with surgeons who performed a higher volume of colon resection procedures per year.
“Postoperatively, we need to consider the full breadth of resources available to patients—physical and occupational therapy needs, nursing needs, and to evaluate if they would benefit from being discharged to another health-care facility,” said Dr. Kaur.
Disclosure: For full disclosures of the study authors, visit facs.org/clincon2019.
