Surgical and functional outcomes and survival following Colon Cancer surgery in the aged: a study protocol for a prospective, observational multicentre study

Susanna Niemeläinen, Heini Huhtala, Anu Ehrlich, Jyrki Kössi, Esa Jämsen, Marja Hyöty, Susanna Niemeläinen, Heini Huhtala, Anu Ehrlich, Jyrki Kössi, Esa Jämsen, Marja Hyöty

Abstract

Background: The number of colorectal cancer patients increases with age. The decision to go through major surgery can be challenging for the aged patient and the surgeon because of the heterogeneity within the older population. Differences in preoperative physical and cognitive status can affect postoperative outcomes and functional recovery, and impact on patients' quality of life.

Methods / design: A prospective, observational, multicentre study including nine hospitals to analyse the impact of colon cancer surgery on functional ability, short-term outcomes (complications and mortality), and their predictors in patients aged ≥80 years. The catchment area of the study hospitals is 3.88 million people, representing 70% of the population of Finland. The data will be gathered from patient baseline characteristics, surgical interventional data, and pre- and postoperative patient-questionnaires, to an electronic database (REDCap) especially dedicated to the study.

Discussion: This multicentre study provides information about colon cancer surgery's operative and functional outcomes on older patients. A further aim is to find prognostic factors which could help to predict adverse outcomes of surgery.

Trial registration: ClinicalTrials.gov ( NCT03904121 ). Registered on 1 April 2019.

Keywords: Aged patients; Colon cancer; Functional ability, short-term outcome; Surgery.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Eligibility criteria

References

    1. Statistics Finland. . Accessed 30 Oct 2020.
    1. Jafari MD, Jafari F, Halabi WJ, Nguyen VQ, Pigazzi A, Carmichael JC, Mills SD, Stamos MJ. Colorectal cancer resections in the aging US population: a trend toward decreasing rates and improved outcomes. JAMA Surg. 2014;149(6):557–564. doi: 10.1001/jamasurg.2013.4930.
    1. Van de Velde CJ, Boelens PG, Borras JM, Coebergh JW, Cervantes A, Blomqvist L, et al. EURECCA colorectal: Multidisciplinary management: European consensus conference colon & rectum. Eur J Cancer. 2014;50(1):1. e 1–1. e 34. doi: 10.1016/j.ejca.2013.06.048.
    1. Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, Köhne CH, Rostoft S, Lemmens V, Mitry E, Rutten H, Sargent D, Sastre J, Seymour M, Starling N, van Cutsem E, Aapro M. Treatment of colorectal Cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations. Ann Oncol. 2015;26(3):463–476. doi: 10.1093/annonc/mdu253.
    1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2.
    1. Huisman MG, Veronese G, Audisio RA, Ugolini G, Montroni I, de Bock GH, van Leeuwen BL, Huisman MG, Veronese G, Audisio RA, Ugolini G, Montroni I, Vigano A, Gilbert L, Spiliotis J, Stabilini C, de Liguori Carino N, Farinella E, Stanojevic G, Veering BT, Reed MW, Somasundar PS, de Bock GH, van Leeuwen BL. Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in Onco-geriatric surgical patients - a multi-Centre cohort study. Eur J Surg Oncol. 2016;42(7):1009–1017. doi: 10.1016/j.ejso.2016.03.005.
    1. Niemeläinen S, Huhtala H, Ehrlich A, Kössi J, Jämsen E, Hyöty M. Risk factors of short-term survival in the aged in elective colon cancer surgery: a population-based study. Int J Color Dis. 2020;35(2):307–315. doi: 10.1007/s00384-019-03488-8.
    1. Montroni I, Ugolini G, Saur NM, Spinelli A, Rostoft S, Millan M, Wolthuis A, Daniels IR, Hompes R, Penna M, Fürst A, Papamichael D, Desai AM, Cascinu S, Gèrard JP, Myint AS, Lemmens VEPP, Berho M, Lawler M, de Liguori Carino N, Potenti F, Nanni O, Altini M, Beets G, Rutten H, Winchester D, Wexner SD, Audisio RA. Personalized management of elderly patients with rectal cancer: expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer. Eur J Surg Oncol. 2018;44(11):1685–1702. doi: 10.1016/j.ejso.2018.08.003.
    1. Seishima R, Okabayashi K, Hasegawa H, Tsuruta M, Shigeta K, Matsui S, Yamada T, Kitagawa Y. Is laparoscopic colorectal surgery beneficial for elderly patients? A systematic review and meta-analysis. J Gastrointest Surg. 2015;19(4):756–765. doi: 10.1007/s11605-015-2748-9.
    1. Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A. A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Color Dis. 2014;16(12):947–956. doi: 10.1111/codi.12718.
    1. Brouwer NPM, Heil TC, Olde Rikkert MGM, Lemmens VEPP, Rutten HJT, de Wilt JHW, van Erning FN. The gap in postoperative outcome between older and younger patients with stage I-III colorectal cancer has been bridged: results from the Netherlands cancer registry. Eur J Cancer. 2019;116:1–9. doi: 10.1016/j.ejca.2019.04.036.
    1. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call for action. J Am Med Dir Assoc. 2013;14(6):392–397. doi: 10.1016/j.jamda.2013.03.022.
    1. Okabe H, Ohsaki T, Ogawa K, Ozaki N, Hayashi H, Akahoshi S, Ikuta Y, Ogata K, Baba H, Takamori H. Frailty predicts severe postoperative complications after elective colorectal surgery. Am J Surg. 2019;217(4):677–681. doi: 10.1016/j.amjsurg.2018.07.009.
    1. Fagard K, Leonard S, Deschodt M, Devriendt E, Wolthuis A, Prenen H, Flamaing J, Milisen K, Wildiers H, Kenis C. The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal Cancer: a systematic review. J Geriatr Oncol. 2016;7(6):479–491. doi: 10.1016/j.jgo.2016.06.001.
    1. Huisman MG, Kok M, de Bock GH, van Leeuwen BL. Delivering tailored surgery to older Cancer patients: preoperative geriatric assessment domains and screening tools - a systematic review of systematic reviews. Eur J Surg Oncol. 2017;43(1):1–14. doi: 10.1016/j.ejso.2016.06.003.
    1. Akishita M, Ishii S, Kojima T, Kozaki K, Kuzuya M, Arai H, Arai H, Eto M, Takahashi R, Endo H, Horie S, Ezawa K, Kawai S, Takehisa Y, Mikami H, Takegawa S, Morita A, Kamata M, Ouchi Y, Toba K. Priorities of health care outcomes for the elderly. J Am Med Dir Assoc. 2013;14(7):479–484. doi: 10.1016/j.jamda.2013.01.009.
    1. Souwer ETD, Oerlemans S, van de Poll-Franse LV, van Erning FN, van den Bos F, Schuijtemaker JS, van den Berkmortel FWPJ, ten Bokkel Huinink D, Hamaker ME, Dekker JWT, Wientjes CA, Portielje JEA, Maas HAA. The impact of colorectal surgery on health-related quality of life in older functionally dependent patients with Cancer - a longitudinal follow-up study. J Geriatr Oncol. 2019;10(5):724–732. doi: 10.1016/j.jgo.2019.04.013.
    1. Rønning B, Wyller TB, Nesbakken A, Skovlund E, Jordhøy MS, Bakka A, Rostoft S. Quality of life in older and frail patients after surgery for colorectal cancer—a follow-up study. J Geriatr Oncol. 2016;7(3):195–200. doi: 10.1016/j.jgo.2016.03.002.
    1. Ghignone F, Hernandez P, Mahmoud NN, Ugolini G. Functional recovery in senior adults undergoing surgery for colorectal cancer: assessment tools and strategies to preserve functional status. Eur J Surg Oncol. 2020;46(3):387–393. doi: 10.1016/j.ejso.2020.01.003.
    1. Karlsson E, Egenvall M, Farahnak P, Bergenmar M, Nygren-Bonnier M, Franzén E, Rydwik E. Better preoperative physical performance reduces the odds of complication severity and discharge to care facility after abdominal Cancer resection in people over the age of 70 - a prospective cohort study. Eur J Surg Oncol. 2018;44(11):1760–1767. doi: 10.1016/j.ejso.2018.08.011.
    1. Montroni I, Rostoft S, Spinelli A, Van Leeuwen BL, Ercolani G, Saur NM, et al. GOSAFE - geriatric oncology surgical assessment and functional rEcovery after surgery: early analysis on 977 patients. J Geriatr Oncol. 2020;11(2):244–255. doi: 10.1016/j.jgo.2019.06.017.
    1. Vermeer NCA, Claassen YHM, Derks MGM, Iversen LH, van Eycken E, Guren MG, Mroczkowski P, Martling A, Johansson R, Vandendael T, Wibe A, Moller B, Lippert H, Portielje JEA, Liefers GJ, Peeters KCMJ, van de Velde CJH, Bastiaannet E. Treatment and survival of patients with Colon Cancer aged 80 years and older: a EURECCA international comparison. Oncologist. 2018;23(8):982–990. doi: 10.1634/theoncologist.2017-0551.
    1. Finnish Cancer Registry. .. Accessed 30 Oct 2020.
    1. Amrock LG, Neuman MD, Lin HM, Deiner S. Can routine preoperative data predict adverse outcomes in the elderly? Development and validation of a simple risk model incorporating a chart-derived frailty score. J Am Coll Surg. 2014;219(4):684–694. doi: 10.1016/j.jamcollsurg.2014.04.018.
    1. Huisman MG, Ghignone F, Ugolini G, Sidorenkov G, Montroni I, Vigano A, Liguori Carino N, Farinella E, Cirocchi R, Audisio RA, Bock GH, Leeuwen BL. Long-term survival and risk of institutionalization in Onco-geriatric surgical patients: long-term results of the PREOP study. J Am Geriatr Soc. 2020;68(6):1235–1241. doi: 10.1111/jgs.16384.
    1. Abdel-Halim M, Wu H, Poustie M, Beveridge A, Scott N, Mitchell PJ. Survival after non-resection of colorectal Cancer: the argument for including non-operatives in consultant outcome reporting in the UK. Ann R Coll Surg Engl. 2019;101(2):126–132. doi: 10.1308/rcsann.2018.0180.
    1. . Accessed 30 Oct 2020.
    1. . Accessed 30 Oct 2020.
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. doi: 10.1097/.
    1. Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med. 2009;69(3):307–316. doi: 10.1016/j.socscimed.2009.05.013.
    1. Bellera CA, Rainfray M, Mathoulin-Pélissier S, Mertens C, Delva F, Fonck M, Soubeyran PL. Screening older Cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23(8):2166–2172. doi: 10.1093/annonc/mdr587.
    1. Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol. 2015;26(2):288–300. doi: 10.1093/annonc/mdu210.
    1. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in geriatric practice: developing the short-form mini nutritional assessment (MNA-SF) J Geront. 2001;56A:M366–M377. doi: 10.1093/gerona/56.6.M366.
    1. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–495. doi: 10.1503/cmaj.050051.
    1. Owens WD, Felts JA, Spitznagel EL., Jr ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49(4):239–243. doi: 10.1097/00000542-197810000-00003.
    1. Chang CM, Yin WY, Wei CK, Wu CC, Su YC, Yu CH, Lee CC. Adjusted age-adjusted Charlson comorbidity index score as a risk measure of perioperative mortality before Cancer surgery. PLoS One. 2016;11(2):e0148076. doi: 10.1371/journal.pone.0148076.
    1. Lahti RA, Penttilä A. The validity of death certificates: routine validation of death certification and its effects on mortality statistics. Forensic Sci Int. 2001;115(1-2):15–32. doi: 10.1016/S0379-0738(00)00300-5.
    1. Mäkelä JT, Klintrup KH, Rautio TT. Mortality and survival after surgical treatment of colorectal cancer in patients aged over 80 years. Gastrointest Tumors. 2017;4(1–2):36–44. doi: 10.1159/000477721.
    1. Claassen YHM, Bastiaannet E, van Eycken E, Van Damme N, Martling A, Johansson R, et al. Time trends of short-term mortality for octogenarians undergoing a colorectal resection in North Europe. Eur J Surg Oncol. 2019;45(8):1396–1402. doi: 10.1016/j.ejso.2019.03.041.
    1. Rostoft S, Hamaker ME. Basic geriatric principles for colorectal surgeons: how to optimize assessment and Care of Older Patients in the perioperative period. Eur J Surg Oncol. 2020;46(3):310–315. doi: 10.1016/j.ejso.2019.07.027.
    1. Niemeläinen S, Huhtala H, Ehrlich A, Kössi J, Jämsen E, Hyöty M. Long-term survival following elective colon cancer surgery in the aged. A population-based cohort study. Colorectal Dis. 2020;9. 10.1111/codi.15242.
    1. Mothes H, Bauschke A, Schuele S, Eigendorff E, Altendorf-Hofmann A, Settmacher U. Surgery for colorectal cancer in elderly patients: how can we improve outcome? J Cancer Res Clin Oncol. 2017;43:1879–1889. doi: 10.1007/s00432-017-2438-y.
    1. Partridge JLS, Harari D, Martin FC, Dhesi JK. The impact of pre-operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review. Anaesthesia. 2014;69(Suppl 1):8–16. doi: 10.1111/anae.12494.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj