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Published in: Updates in Surgery 3/2020

01-09-2020 | Rectal Cancer | Original Article

Should radical surgery for rectal cancer be offered to elderly population? A propensity-matching analysis on short- and long-term outcomes

Authors: Nicolò Tamini, Alessandro Giani, Simone Famularo, Mauro Montuori, Vittorio Giardini, Luca Gianotti

Published in: Updates in Surgery | Issue 3/2020

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Abstract

Elderly patients with rectal tumor are often undertreated if compared to younger ones. The reasons for this attitude are not fully clear.The aim of this study was to determine the feasibility of radical treatments for rectal cancer in subjects with an age ≥ 75 years (group 1) and to compare short- and long-term outcomes of these patients with patients with an age of less that 75 years (group 2). 311 consecutive patients who underwent radical surgery for rectal cancer were evaluated. A propensity-matching analysis on short- and long-term outcomes was conducted to compare older and younger patients. Overall postoperative complication rate was 23.8% (19/80) in the group 2 and 33.8% (27/80) in group 1 (p = 0.162). OS at 1, 3 and 5 years was 96.2%, 88.4% and 75.9% in under 75 and 92.5%, 64.3% and 50.6% in over 75 group, respectively (p = 0.001). However, TSS was considered, no significant difference was found. Major complications were comparable within groups: 10 (12.5%) versus 11 (13.8%) in groups 2 and 1, respectively (p = 0.633). This study suggests that major rectal cancer surgery with curative intent should not be denied to an elderly population on the basis of age alone. Specific oncologic features and comorbidities are better long-term mortality predictors than aging.
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Literature
1.
go back to reference Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403PubMedCrossRef Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403PubMedCrossRef
2.
go back to reference Rutten HJT, den Dulk M, Lemmens VEPP, van de Velde CJH, Marijnen CAM (2008) Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol 9(5):494–501PubMedCrossRef Rutten HJT, den Dulk M, Lemmens VEPP, van de Velde CJH, Marijnen CAM (2008) Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol 9(5):494–501PubMedCrossRef
3.
go back to reference Day JC (1996) Population projections of the United States, by age, sex, race, and hispanic origin: 1992 to 2050, U.S. Bureau of the Census, Current Population Reports, U.S. Government Printing Office, Washington, DC, pp 25–1130 Day JC (1996) Population projections of the United States, by age, sex, race, and hispanic origin: 1992 to 2050, U.S. Bureau of the Census, Current Population Reports, U.S. Government Printing Office, Washington, DC, pp 25–1130
7.
go back to reference Etzioni DA, Liu JH, O’Connell JB, Maggard MA, Ko CY (2003) Elderly patients in surgical workloads: a population-based analysis. Am Surg 69(11):961–965PubMed Etzioni DA, Liu JH, O’Connell JB, Maggard MA, Ko CY (2003) Elderly patients in surgical workloads: a population-based analysis. Am Surg 69(11):961–965PubMed
8.
go back to reference Kwok AC, Semel ME, Lipsitz SR et al (2011) The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet 378(9800):1408–1413PubMedCrossRef Kwok AC, Semel ME, Lipsitz SR et al (2011) The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet 378(9800):1408–1413PubMedCrossRef
9.
go back to reference Cooper Z, Courtwright A, Karlage A, Gawande A, Block S (2014) Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg 260(6):949–957PubMedCrossRef Cooper Z, Courtwright A, Karlage A, Gawande A, Block S (2014) Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg 260(6):949–957PubMedCrossRef
11.
go back to reference Endreseth BH, Romundstad P, Myrvold HE, Bjerkeset T, Wibe A (2006) The Norwegian Rectal Cancer Group. Rectal cancer treatment of the elderly. Colorectal Dis 8(6):471–479PubMedCrossRef Endreseth BH, Romundstad P, Myrvold HE, Bjerkeset T, Wibe A (2006) The Norwegian Rectal Cancer Group. Rectal cancer treatment of the elderly. Colorectal Dis 8(6):471–479PubMedCrossRef
12.
go back to reference Barrier A, Ferro L, Houry S, Lacaine F, Huguier M (2003) Rectal cancer surgery in patients more than 80 years of age. Am J Surg 185(1):54–57PubMedCrossRef Barrier A, Ferro L, Houry S, Lacaine F, Huguier M (2003) Rectal cancer surgery in patients more than 80 years of age. Am J Surg 185(1):54–57PubMedCrossRef
13.
go back to reference US Preventive Services Task Force (2008) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 149(9):627–637CrossRef US Preventive Services Task Force (2008) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 149(9):627–637CrossRef
14.
go back to reference Townsley CA, Selby R, Siu LL (2005) Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol 23(13):3112–3124PubMedCrossRef Townsley CA, Selby R, Siu LL (2005) Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol 23(13):3112–3124PubMedCrossRef
16.
go back to reference Chesney TR, Pang G, Ahmed N (2018) Caring for older surgical patients: contemporary attitudes, knowledge, practices, and needs of general surgeons and residents. Ann Surg 268(1):77–85PubMedCrossRef Chesney TR, Pang G, Ahmed N (2018) Caring for older surgical patients: contemporary attitudes, knowledge, practices, and needs of general surgeons and residents. Ann Surg 268(1):77–85PubMedCrossRef
17.
go back to reference Suhool A, Moszkowicz D, Cudennec T et al (2018) Optimal oncologic treatment of rectal cancer in patients over 75 years old: results of a strategy based on oncogeriatric evaluation. J Visc Surg 155(1):17–25PubMedCrossRef Suhool A, Moszkowicz D, Cudennec T et al (2018) Optimal oncologic treatment of rectal cancer in patients over 75 years old: results of a strategy based on oncogeriatric evaluation. J Visc Surg 155(1):17–25PubMedCrossRef
18.
go back to reference von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4(10):e296CrossRef von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4(10):e296CrossRef
19.
go back to reference Burnet NG, Jefferies SJ, Benson RJ, Hunt DP, Treasure FP (2005) Years of life lost (YLL) from cancer is an important measure of population burden—and should be considered when allocating research funds. Br J Cancer 92(2):241–245PubMedPubMedCentralCrossRef Burnet NG, Jefferies SJ, Benson RJ, Hunt DP, Treasure FP (2005) Years of life lost (YLL) from cancer is an important measure of population burden—and should be considered when allocating research funds. Br J Cancer 92(2):241–245PubMedPubMedCentralCrossRef
20.
go back to reference Chang C-M, Yin W-Y, Wei C-K et al (2016) Correction: adjusted age-adjusted Charlson Comorbidity Index Score as a risk measure of perioperative mortality before cancer surgery. PLoS ONE One 11(6):e0157900CrossRef Chang C-M, Yin W-Y, Wei C-K et al (2016) Correction: adjusted age-adjusted Charlson Comorbidity Index Score as a risk measure of perioperative mortality before cancer surgery. PLoS ONE One 11(6):e0157900CrossRef
21.
go back to reference Gardner JW, Sanborn JS (1990) Years of Potential Life Lost (YPLL)—what does it measure? Epidemiology 1:322–329PubMedCrossRef Gardner JW, Sanborn JS (1990) Years of Potential Life Lost (YPLL)—what does it measure? Epidemiology 1:322–329PubMedCrossRef
23.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRef
24.
go back to reference Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828PubMedPubMedCentralCrossRef Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828PubMedPubMedCentralCrossRef
25.
go back to reference Sandini M, Pinotti E, Persico I, Picone D, Bellelli G, Gianotti L (2017) Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open 1(5):128–137PubMedPubMedCentralCrossRef Sandini M, Pinotti E, Persico I, Picone D, Bellelli G, Gianotti L (2017) Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open 1(5):128–137PubMedPubMedCentralCrossRef
26.
go back to reference Manceau G, Karoui M, Werner A, Mortensen NJ, Hannoun L (2012) Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients: a systematic review. Lancet Oncol 13(12):e525–e536PubMedCrossRef Manceau G, Karoui M, Werner A, Mortensen NJ, Hannoun L (2012) Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients: a systematic review. Lancet Oncol 13(12):e525–e536PubMedCrossRef
27.
go back to reference Symeonidis D, Christodoulidis G, Koukoulis G, Spyridakis M, Tepetes K (2011) Colorectal cancer surgery in the elderly: limitations and drawbacks. Tech Coloproctol 15(Suppl 1):S47–S50PubMedCrossRef Symeonidis D, Christodoulidis G, Koukoulis G, Spyridakis M, Tepetes K (2011) Colorectal cancer surgery in the elderly: limitations and drawbacks. Tech Coloproctol 15(Suppl 1):S47–S50PubMedCrossRef
28.
go back to reference Revenig LM, Canter DJ, Henderson MA et al (2015) Preoperative quantification of perceptions of surgical frailty. J Surg Res 193(2):583–589PubMedCrossRef Revenig LM, Canter DJ, Henderson MA et al (2015) Preoperative quantification of perceptions of surgical frailty. J Surg Res 193(2):583–589PubMedCrossRef
29.
go back to reference Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC Jr, Moss M (2013) Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 206(4):544–550PubMedPubMedCentralCrossRef Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC Jr, Moss M (2013) Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 206(4):544–550PubMedPubMedCentralCrossRef
31.
go back to reference Gardner JW, Sanborn JS (1990) Years of potential life lost (YPLL)—what does it measure? Epidemiology 1(4):322–329PubMedCrossRef Gardner JW, Sanborn JS (1990) Years of potential life lost (YPLL)—what does it measure? Epidemiology 1(4):322–329PubMedCrossRef
32.
go back to reference Smith JJ, Lee J, Burke C, Contractor KB, Dawson PM (2002) Major colorectal cancer resection should not be denied to the elderly. Eur J Surg Oncol 28(6):661–666PubMedCrossRef Smith JJ, Lee J, Burke C, Contractor KB, Dawson PM (2002) Major colorectal cancer resection should not be denied to the elderly. Eur J Surg Oncol 28(6):661–666PubMedCrossRef
33.
go back to reference Colorectal Cancer Collaborative Group (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 356(9234):968–974CrossRef Colorectal Cancer Collaborative Group (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 356(9234):968–974CrossRef
34.
go back to reference Puig-La Calle J, Quayle J, Thaler HT et al (2000) Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older. Dis Colon Rectum 43(12):1704–1709PubMedCrossRef Puig-La Calle J, Quayle J, Thaler HT et al (2000) Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older. Dis Colon Rectum 43(12):1704–1709PubMedCrossRef
35.
go back to reference Neugut AI, Fleischauer AT, Sundararajan V et al (2002) Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly: a population-based study. J Clin Oncol 20(11):2643–2650PubMedCrossRef Neugut AI, Fleischauer AT, Sundararajan V et al (2002) Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly: a population-based study. J Clin Oncol 20(11):2643–2650PubMedCrossRef
37.
go back to reference Papamichael D, Audisio RA, Glimelius B et al (2015) Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 26(3):463–476PubMedCrossRef Papamichael D, Audisio RA, Glimelius B et al (2015) Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 26(3):463–476PubMedCrossRef
39.
go back to reference Fleshman J, Branda M, Sargent DJ et al (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355PubMedPubMedCentralCrossRef Fleshman J, Branda M, Sargent DJ et al (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355PubMedPubMedCentralCrossRef
40.
go back to reference Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363CrossRefPubMed Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363CrossRefPubMed
Metadata
Title
Should radical surgery for rectal cancer be offered to elderly population? A propensity-matching analysis on short- and long-term outcomes
Authors
Nicolò Tamini
Alessandro Giani
Simone Famularo
Mauro Montuori
Vittorio Giardini
Luca Gianotti
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 3/2020
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-020-00717-6

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