Surgical outcomes in elderly patients with obstructed colorectal cancer: Single center experience
Year 2020,
Volume: 53 Issue: 3, 196 - 201, 31.12.2020
Enis Dikicier
,
Muhammed Kamburoğlu
,
Emre Gönüllü
,
Yeşim Akdeniz
,
Kayhan Özdemir
,
Barış Mantoğlu
,
Havva Koçer
,
Fehmi Çelebi
Abstract
Aim: Colorectal cancer is the most common cause of large bowel ob-struction in elderly. The aim of this study is to compare the clinical findings and perioperative outcomes of elder and younger colorectal cancer patients who were urgently operated for obstruction in our de-partment.
Material and Method: The files of patients who underwent emergency surgery for acute mechanical bowel obstruction due to colorectal cancer between January 2015 and December 2019 at the Sakarya University School of Medicine, Department of General Surgery were retrospective-ly reviewed.
Results: A total of 187 patients who had emergency operation due to colorectal cancer-related obstruction in a 5-year period were included. 55.6% (n = 104) were over the age of 65, 46.4% (n = 83) were under the age of 65. ASA scores, tumor localization, and mean total hospital stay, duration of intensive care were statistically different between the two groups (p <0.05, p <0.022, p = 0.011). No significant difference de-tected in terms of mortality (p = 0.103).
Conclusion: Obstructive colorectal cancers in geriatric patients who re-quire emergency surgery form a more challenging group than the elec-tive conditions. Our study shows that similar outcomes can be achieved in terms of postoperative complications, early mortality and oncological principles; with the younger cohort.
References
- 1) Douaiher J, Ravipati A, Grams B, et al. Colorectal cancer-global burden, trends, and geographical variations. J Surg Oncol. 2017; 115(5): 619–30.
- 2) Bayraktar B, Ozemir IA, Kefeli U, et al. Colorectal stenting for palliation and as a bridge to surgery: A 5-year follow-up study. World J Gastroenterol. 2015; Aug 21; 21(31): 9373-79.
- 3) Costa G, Frezza B, Fransvea P, , et al. Clinico-pathological features of colon cancer patients undergoing emergency surgery: a comparison be-tween elderly and non-elderly patients. Open Med (Wars). 2019; Oct 2; 14: 726-34. doi: 10.1515/med-2019-0082.
- 4) Greenlee RT, Hill-Harmon MB, Murray T, et al. Cancer statistics, 2001. Ca-A Cancer Journal of Clinicians. 2001 ; 51: 15-36
- 5) Kluger Y, Ben-Ishay O, Sartelli M, et al. World society of emergency surgery study group initiative on Timing of Acute Care Surgery classification (TACS). World J Emerg Surg. 2013; 8: 17
- 6) Clavien P, Sanabria J, Strasberg S. Proposed classification of complication of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111: 518–26.
- 7) Smothers L, Hynan L, Fleming J,et al. Emergency surgery for colon carcinoma. Diseases of the Colon and Rectum. 2003; 1: 24-30
- 8) Hermans E, van Schaik PM, Prins HA, et al. Outcome of colonic surgery in elderly patients with colon cancer. J Oncol. 2010; 2010: 865-908. Doi:10.1155/2010/865908
- 9) Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014. CA Cancer J Clin. Jan-Feb 2014; 64(1): 9-29. doi: 10.3322/caac.21208.
- 10) Menegozzo CAM ,Teixeira Jr F, Couto Netto SD, et al. Outcomes of Elderly Patients Undergoing Emergency Surgery for Complicated Colorectal Cancer: A Retrospective Cohort Study. Clinics (Sao Paulo). 2019; 74:e1074. Published online 2019 Aug 13. doi: 10.6061/clinics/2019/e1074
- 11) Aquina CT, Becerra AZ, Xu Z, et al. Nonelective colon cancer resection: A continued public health concern. Surgery. 2017; 161(6): 1609-18. https://doi.org/10.1016/j.surg. 2017.01.001
- 12) Balducci L, Aapro M. Complicated and complex: helping the older patient with cancer to exit the labyrinth. J Geriatr Oncol. 2014; 5: 116-18.
- 13) Hsu T.C. Comparison of One-Stage Resection and Anastomosis of Acute Complete Obstruction of Left and Right Colon. Am J Surg. 2005; Apr; 189(4): 384-87. doi: 10.1016/j.amjsurg.2004.06.046.
- 14) K.K. Tan, R. Sim. Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left and right-sided cancers. J Gastrointest Surg. 14 (2010), pp. 295-302
- 15) Webster PJ , Aldoori J, Burke DA. Optimal management of malignant left-sided large bowel obstruction: do international guidelines agree? World J Emerg Surg. 2019; 14: 23. Published online 2019 May 22. doi: 10.1186/s13017-019-0242-5 PMCID: PMC6530001
- 16) Ghazal AH, El-Shazly WG, Bessa SS, et al. Colonic Endolumenal Stenting Devices and Elective Surgery Versus Emergency Subtotal/Total Colectomy in the Management of Malignant Obstructed Left Colon Carcinoma. J Gastrointest Surg. 2013 Jun; 17(6): 1123-29. doi: 10.1007/s11605-013-2152-2. Epub 2013 Jan 29. PMID: 23358847
- 17) NCCN Clinical practice guidelines in Oncology: Colon Cancer. Available at www.nccn.org. Accessed March 10, 2013.
- 18) Bilimoria KY, Stewart AK, Palis BE, et al. Adequacy and importance of lymph node evaluation for colon cancer in the elderly. J Am Coll Surg. 2008; 206: 247–54.
- 19) Chang GJ, Rodriguez-Bigas MA, Skibber JM, et al. Lymph node evaluation and survival after curative resection of colon cancer: Systematic review. J Natl Cancer Inst. 2007; 99: 433–41.
- 20) Xu Z, Becerra AZ, Aquina CT, et al. Emergent Colectomy Is Independently Associated with Decreased Long Term Overall Survival in Colon Cancer Patients. J Gastrointest Surg. 2017; 21(3): 543-53. https://doi.org/10.1007/ s11605-017-3355-8
- 21) Sjo OH, Larsen S, Lunde OC, et al. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis. 2009; 11(7): 733–39.
Obstruksiyona neden olmuş kolorektal kanserli yaşlı hastalarda acil cerrahi sonuçları: Tek merkez deneyimi
Year 2020,
Volume: 53 Issue: 3, 196 - 201, 31.12.2020
Enis Dikicier
,
Muhammed Kamburoğlu
,
Emre Gönüllü
,
Yeşim Akdeniz
,
Kayhan Özdemir
,
Barış Mantoğlu
,
Havva Koçer
,
Fehmi Çelebi
Abstract
Amaç: Kolorektal kanserler, yaşlılarda kalın bağırsak tıkanıklığının en yaygın nedenidir. Bu çalışmanın amacı, bölümümüzde acil olarak ob-strüksiyon nedeniyle ameliyat edilen yaşlı ve genç kolorektal kanserli hastaların klinik bulgularını ve perioperatif sonuçlarını karşılaştırmaktır.
Gereç ve Yöntem: Sakarya Üniversitesi Tıp Fakültesi Genel Cerrahi Anabilim Dalı'nda Ocak 2015-Aralık 2019 tarihleri arasında kolorektal kansere bağlı akut mekanik barsak tıkanıklığı nedeniyle acil ameliyat edilen hastaların dosyaları retrospektif olarak incelendi.
Bulgular: 5 yıllık sürede kolorektal kansere bağlı tıkanıklık nedeniyle acil ameliyat olmuş toplam 187 hasta dahil edildi. % 55,6'sı (n = 104) 65 yaş üzerinde,% 46,4'ü (n = 83) 65 yaşın altındaydı. ASA skorları, tümör lokalizasyonu ve ortalama toplam hastanede kalış süresi, yoğun bakım süresi iki grup arasında istatistiksel olarak farklıydı (p <0.05, p <0.022, p = 0.011). Mortalite açısından gruplar arasında anlamlı bir fark saptanmadı (p = 0.103).
Sonuç: Acil cerrahi gerektiren geriatrik hastalarda obstrüktif kolorektal kanserler, seçici koşullara göre daha zorlayıcı bir grup oluşturmaktadır. Çalışmamız, geriatrik gruptaki hastalarda postoperatif komplikasyonlar, erken mortalite ve onkolojik prensipler açısından genç grup ile benzer sonuçların elde edilebileceğini göstermektedir.
References
- 1) Douaiher J, Ravipati A, Grams B, et al. Colorectal cancer-global burden, trends, and geographical variations. J Surg Oncol. 2017; 115(5): 619–30.
- 2) Bayraktar B, Ozemir IA, Kefeli U, et al. Colorectal stenting for palliation and as a bridge to surgery: A 5-year follow-up study. World J Gastroenterol. 2015; Aug 21; 21(31): 9373-79.
- 3) Costa G, Frezza B, Fransvea P, , et al. Clinico-pathological features of colon cancer patients undergoing emergency surgery: a comparison be-tween elderly and non-elderly patients. Open Med (Wars). 2019; Oct 2; 14: 726-34. doi: 10.1515/med-2019-0082.
- 4) Greenlee RT, Hill-Harmon MB, Murray T, et al. Cancer statistics, 2001. Ca-A Cancer Journal of Clinicians. 2001 ; 51: 15-36
- 5) Kluger Y, Ben-Ishay O, Sartelli M, et al. World society of emergency surgery study group initiative on Timing of Acute Care Surgery classification (TACS). World J Emerg Surg. 2013; 8: 17
- 6) Clavien P, Sanabria J, Strasberg S. Proposed classification of complication of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111: 518–26.
- 7) Smothers L, Hynan L, Fleming J,et al. Emergency surgery for colon carcinoma. Diseases of the Colon and Rectum. 2003; 1: 24-30
- 8) Hermans E, van Schaik PM, Prins HA, et al. Outcome of colonic surgery in elderly patients with colon cancer. J Oncol. 2010; 2010: 865-908. Doi:10.1155/2010/865908
- 9) Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014. CA Cancer J Clin. Jan-Feb 2014; 64(1): 9-29. doi: 10.3322/caac.21208.
- 10) Menegozzo CAM ,Teixeira Jr F, Couto Netto SD, et al. Outcomes of Elderly Patients Undergoing Emergency Surgery for Complicated Colorectal Cancer: A Retrospective Cohort Study. Clinics (Sao Paulo). 2019; 74:e1074. Published online 2019 Aug 13. doi: 10.6061/clinics/2019/e1074
- 11) Aquina CT, Becerra AZ, Xu Z, et al. Nonelective colon cancer resection: A continued public health concern. Surgery. 2017; 161(6): 1609-18. https://doi.org/10.1016/j.surg. 2017.01.001
- 12) Balducci L, Aapro M. Complicated and complex: helping the older patient with cancer to exit the labyrinth. J Geriatr Oncol. 2014; 5: 116-18.
- 13) Hsu T.C. Comparison of One-Stage Resection and Anastomosis of Acute Complete Obstruction of Left and Right Colon. Am J Surg. 2005; Apr; 189(4): 384-87. doi: 10.1016/j.amjsurg.2004.06.046.
- 14) K.K. Tan, R. Sim. Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left and right-sided cancers. J Gastrointest Surg. 14 (2010), pp. 295-302
- 15) Webster PJ , Aldoori J, Burke DA. Optimal management of malignant left-sided large bowel obstruction: do international guidelines agree? World J Emerg Surg. 2019; 14: 23. Published online 2019 May 22. doi: 10.1186/s13017-019-0242-5 PMCID: PMC6530001
- 16) Ghazal AH, El-Shazly WG, Bessa SS, et al. Colonic Endolumenal Stenting Devices and Elective Surgery Versus Emergency Subtotal/Total Colectomy in the Management of Malignant Obstructed Left Colon Carcinoma. J Gastrointest Surg. 2013 Jun; 17(6): 1123-29. doi: 10.1007/s11605-013-2152-2. Epub 2013 Jan 29. PMID: 23358847
- 17) NCCN Clinical practice guidelines in Oncology: Colon Cancer. Available at www.nccn.org. Accessed March 10, 2013.
- 18) Bilimoria KY, Stewart AK, Palis BE, et al. Adequacy and importance of lymph node evaluation for colon cancer in the elderly. J Am Coll Surg. 2008; 206: 247–54.
- 19) Chang GJ, Rodriguez-Bigas MA, Skibber JM, et al. Lymph node evaluation and survival after curative resection of colon cancer: Systematic review. J Natl Cancer Inst. 2007; 99: 433–41.
- 20) Xu Z, Becerra AZ, Aquina CT, et al. Emergent Colectomy Is Independently Associated with Decreased Long Term Overall Survival in Colon Cancer Patients. J Gastrointest Surg. 2017; 21(3): 543-53. https://doi.org/10.1007/ s11605-017-3355-8
- 21) Sjo OH, Larsen S, Lunde OC, et al. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis. 2009; 11(7): 733–39.