Clinical Interventions in Aging (May 2016)
Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians
Abstract
Young Wan Kim, Ik Yong Kim Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea Purpose: To identify the factors affecting 30-day postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Methods: Between 2005 and 2014, a total of 204 consecutive patients aged ≥80 years who underwent major colorectal surgery were included. Results: One hundred patients were male (49%) and 52 patients had American Society of Anesthesiologists (ASA) score ≥3 (25%). Combined surgery was performed in 32 patients (16%). Postoperative complications within 30 days after surgery occurred in 54 patients (26%) and 30-day mortality occurred in five patients (2%). Independent risk factors affecting 30-day postoperative complications were older age (≥90 years, hazard ratio [HR] with 95% confidence interval [CI] =4.95 [1.69-14.47], P=0.004), an ASA score ≥3 (HR with 95% CI =4.19 [1.8-9.74], P=0.001), performance of combined surgery (HR with 95% CI =3.1 [1.13-8.46], P=0.028), lower hemoglobin level (<10 g/dL, HR with 95% CI =7.56 [3.07-18.63], P<0.001), and lower albumin level (<3.4 g/dL, HR with 95% CI =3.72 [1.43-9.69], P=0.007). An ASA score ≥3 (HR with 95% CI =2.72 [1.15-6.46], P=0.023), tumor-node-metastasis (TNM) stage IV (HR with 95% CI =3.47 [1.44-8.39], P=0.006), and occurrence of postoperative complications (HR with 95% CI =4.42 [1.39-14.09], P=0.012) were significant prognostic factors for 1-year mortality. Conclusion: Patient-related factors (older age, higher ASA score, presence of anemia, and lower serum albumin) and procedure-related factors (performance of combined surgical procedure) increased postoperative complications. Avoidance of 30-day postoperative complications may decrease 1-year mortality. Keywords: colonic neoplasms, rectal neoplasms, laparoscopy, laparotomy, aged 80 years and above
