Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians

Figures & data

Table 1 Patient characteristics (n=204)

Variables	N (%) or mean (±SD)
Age (continuous) (years)	84 (±4)
Age (binary)
80–89 years old	181 (89%)
90–99 years old	23 (11%)
Sex
Male	100 (49%)
Body mass index (kg/m^2)	23 (±4)
ASA score (≥3)	52 (25%)
Comorbidity
Diabetes	42 (21%)
Cardiac disease	123 (60%)
Pulmonary disease	31 (15%)
Kidney disease	2 (1%)
Liver disease	5 (2%)
Two or more comorbidities	55 (27%)
Preoperative chemoradiation (+)	8 (4%)
Tumor location
Colon	110 (54%)
Rectum	94 (46%)
Types of operation
Abdominoperineal resection, Hartmann	24 (12%)
Low anterior resection	75 (37%)
Left colectomy	48 (24%)
Subtotal colectomy	5 (2%)
Right colectomy	47 (23%)
Other	5 (2%)
Surgical approach
Open surgery	80 (39%)
Laparoscopy	124 (61%)
Conversion to open surgery (+)	10 (8.1%)
Metastasectomy (−) and organs
Liver	9 (4.4%)
Lung	5 (2.5%)
Peritoneum	3 (1.5%)
Bone	2 (1.0%)
Lung, liver, and bone	1 (0.5%)
Metastasectomy (+) and organs
Liver	6 (2.9%)
Vagina wall	2 (1.0%)
Bladder	1 (0.5%)

Abbreviations: SD, standard deviation; ASA, American Society of Anesthesiologists.

Table 2 Pathological and laboratory data (n=204)

Variables	N (%) or mean (±SD)
pTNM
I	35 (17%)
II	66 (32%)
III	74 (36%)
IV	29 (14%)
Retrieved lymph nodes (number)	20 (±9)
Histologic grade
G3, other	20 (10%)
Tumor size (cm)	5 (±2)
Laboratory dataa (reference value)
White blood cell count (4.0–10.0) (E9/L)	7.5 (±3.1)
Hemoglobin (13.5–17.0) (g/dL)	11.7 (±2.2)
Platelet (165–360) (E9/L)	299 (±112)
Neutrophil (1.8–7.5) (E9/L)	5 (±3)
Lymphocyte (1.0–2.8) (E9/L)	1.7 (±0.7)
C-reactive protein (<0.30) (mg/dL)	1.7 (±3.2)
Albumin (3.2–5.5) (g/dL)	3.9 (±0.4)

Note:

a Values at the time of initial diagnosis.

Abbreviations: SD, standard deviation; pTNM, pathological tumor-node-metastasis.

Table 3 Short-term outcomes (n=204)

Variables	N (%) or mean (±SD)
Operative time (minutes)	188 (±77)
Estimated blood loss (mL)	127 (±204)
30-day complication (+)	54 (26%)
30-day mortality (+)	5 (2%)
Clavien–Dindo score ≥3	22 (11%)
Type of complicationa
Pulmonary	17
Wound	15
Leakage	6
Urinary	5
Bleeding	5
Cardiac	4
Ileus	3
Other	6
Intensive care unit admission (+)	94 (46%)
Blood transfusion (+)	72 (35%)
Time to soft diet (days)	6 (±3)
Hospital stay (days)	14 (±10)
Postoperative chemotherapy (+)	82 (40%)
Chemotherapy regimen
Fluoropyrimidine	75 (37%)
FOLFOX	5 (2%)
FOLFIRI	2 (1%)
Time to chemotherapy initiation (days)	38 (±10)

Note:

a Eight of 204 patients (3.9%) had more than one type of complication.

Abbreviations: SD, standard deviation; FOLFOX, folinic acid, fluorouracil, oxaliplatin; FOLFIRI, folinic acid, fluorouracil, irinotecan.

Table 4 Factors associated with 30-day postoperative complications in logistic regression analysis (n=204)

Variables	Univariable		Multivariable
	HR (95% CI)	P-value	HR (95% CI)	P-value
Age (years)
≥90 vs <90	4.44 (1.81–10.86)	0.001	4.95 (1.69–14.47)	0.004
Sex
Male	1.17 (0.63–2.17)	0.627	NA
ASA score
≥3	4.43 (2.24–8.75)	<0.001	4.19 (1.8–9.74)	0.001
BMI (kg/m^2)
≥30	1.2 (0.3–4.82)	0.796	NA
Tumor location
Rectum	1.01 (0.54–1.89)	0.970	2.22 (0.97–5.04)	0.058
Laparoscopy
(+)	0.49 (0.26–0.93)	0.028	0.77 (0.35–1.7)	0.518
Combined surgery
(+)	3.01 (1.38–6.57)	0.006	3.1 (1.13–8.46)	0.028
Operative time (minutes)
≥300	1.3 (0.38–4.44)	0.672	NA
Blood loss (mL)
≥150	1.22 (0.52–2.86)	0.653	NA
Hemoglobin (g/dL)a
≥10 vs <10	6.21 (2.94–13.13)	<0.001	7.56 (3.07–18.63)	<0.001
Albumin (g/dL)a
≥3.4 vs <3.4	4.5 (2.07–9.79)	<0.001	3.72 (1.43–9.69)	0.007

Note:

a Values at the time of initial diagnosis.

Abbreviations: HR, hazard ratio; CI, confidence interval; NA, not applied; ASA, American Society of Anesthesiologists; BMI, body mass index.

Table 5 Factors associated with 1-year mortality in Cox proportional hazard model (n=204)

Variables	Univariable		Multivariable
	HR (95% CI)	P-value	HR (95% CI)	P-value
Age (years)
≥90 vs <90	1.5 (0.35–6.35)	0.581	0.23 (0.05–1.03)	0.054
Sex
Male	1.75 (0.78–3.92)	0.175	NA
ASA score
≥3	2.31 (1.06–5.04)	0.035	2.72 (1.15–6.46)	0.023
BMI (kg/m^2)
≥30	1.41 (0.19–10.4)	0.737	NA
Tumor location
Rectum	1.35 (0.62–2.91)	0.450	1.09 (0.39–3.06)	0.873
pTNM
IV vs I, II, III	4.15 (1.88–9.15)	<0.001	3.47 (1.44–8.39)	0.006
Laparoscopy
(+)	0.47 (0.22–1.02)	0.056	NA
Hemoglobin (g/dL)a
<10 vs ≥10	1.68 (0.7–3.99)	0.243	NA
Albumin (g/dL)a
<3.4 vs ≥3.4	1.28 (0.48–3.4)	0.619	NA
30-day complication
(+)	3.63 (1.68–7.85)	0.001	4.42 (1.39–14.09)	0.012

Note:

a Values at the time of initial diagnosis.

Abbreviations: HR, hazard ratio; CI, confidence interval; NA, not applied; ASA, American Society of Anesthesiologists; BMI, body mass index; pTNM, pathological tumor-node-metastasis.

Table 6 Literature review regarding colorectal cancer operations in patients aged ≥80 years

Authors	N	Location	Emergency	ASA ≥3 (%)	OT (minutes)	Conv (%)	Diet (days)	LOS (days)	Cx (%)	AL (%)	Mortality (%)	Comments
Vignali et al^Citation16	O: 61 L: 61	Colon, rectum	Excluded	O: 2.6a L: 2.5a	O: 171 L: 220*	6.1	O: 5.9 L: 4.8b,*	O: 12.9 L: 9.8*	O: 31.1 L: 21.5	O: 5 L: 7	O: 3.3 L: 1.6	Case-matched series
Gurevitch et al^Citation15	40	Right colon	Included	23	NR	NR	NR	7.5	27.5	NR	10
Kunitake et al^Citation13	26,108 (Cancer Registry)	Colon, rectum	Included	NR	NR	NR	NR	10.6–12.4 (colon) 11.4–12.6 (rectum)	NR	NR	6	One-year mortality
Chaudhary et al^Citation14	173	Colon, rectum	NR	42	NR	7.5	NR	5	12	1.2	1.7	Short-term outcomes
Current study	204	Colon, rectum	Excluded	25	188	8.1	6	14	26	2.5	2

Notes:

* P<0.05;

a mean;

b return to bowel function.

Abbreviations: ASA, American Society of Anesthesiologists score; OT, operative time; Conv, conversion to open surgery; Diet, time to diet; LOS, length of stay; Cx, postoperative complication; L, laparoscopy; O, open surgery; NR, not reported; AL, anastomotic leakage.

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