Outcome of colorectal cancer surgery in nonagenarians: The 20-year experience from a tertiary centre

Abstract

Introduction: Hong Kong’s women and men enjoy the longest life expectancy in the world. Infants born nowadays are expected to live beyond their 80s. However, increasing age is a well-known risk factor for perioperative morbidity and mortality. The purpose of this study is to evaluate the outcomes and predictive factors of elective and emergency colorectal cancer surgery in patients aged ≥ 90. Materials & Methods: Retrospective analysis of a prospectively collected database for all consecutive patients aged ≥ 90 with colorectal cancer was performed for a period between January 1996 and December 2015. Baseline characteristics, premorbid scores (ASA, ECOG, Charlson comorbidity index), acuity and approach of surgery, tumor characteristics, treatment, complications, mortality and survival were analyzed. This study was conducted in a tertiary referral hospital. Results: A total of 57 patients were selected for analysis. The majority of them were women (64.9%), ASA score II to III (94.7%) and ECOG 3 (49.1%). The median age was 92 years. There was no lost of follow-up. Most of the surgery was curative intent (77.2%), performed under elective setting (57.9%) and with open approach (78.9%). A total of 36.9% of patients had postoperative complications, and 38.1% out of which were pneumonia. The 30-day mortality rate was 7%, all attributed to pneumonia. The 180-day mortality rate was 31.6%. The most common cause was again pneumonia (42.9%), followed by terminal malignancy (21.4%). In univariate analysis, patient with ASA IV and history of ischaemic heart disease were at higher risk of developing complications, 30-day and 180-day mortality. While suffering from pulmonary or any complication were associated with a higher mortality rate at both 30-day (p=<0.001,p=0.012) and 180-day (p=0.001,p=0.005). Hypoalbuminaemia was also associated with higher 30-day and 180-day mortality (p=0.041,p=0.008). In multivariate analysis, emergency surgery (p=0.025, RR4.2) and ischaemic heart disease (p=0.016, RR17.6) were independently associated with higher risk of postoperative complications; while pulmonary complication (p=0.004, RR 33.1) and pre-op high white cell count (p=0.005, RR 1.33) were independent risk factor of 180-day mortality.