Overall survival in elderly patients with acute complications of colorectal cancer

Abstract

AIM: to assess risk factors affecting the five-year overall survival in patients ≥ 70 years old who underwent emergency surgery for complicated colorectal cancer.PATIENTS AND METHODS: a cohort retrospective study included 268 patients with complicated colorectal cancer for the period from January 10, 2010 to March 03, 2020, operated on in hospitals in Smolensk. Inclusion criteria: 1) patients underwent emergency surgery for decompensated bowel obstruction or tumor perforation with peritonitis; 2) histological type of tumor: adenocarcinoma, signet ring cell carcinoma, undifferentiated cancer; 3) age ≥ 70 years. Non-inclusion criteria: 1) subcompensated bowel obstruction, paratumoral inflammation, intestinal bleeding; 2) non-epithelial malignant tumors; 3) age < 70 years.RESULTS: the significant differences were revealed in overall survival rates depending on the type of surgery. In complicated colon cancer, overall survival after one-stage surgeries was 15.35%, after tumor removal at the first stage — 21.51%, and after surgeries with tumor removal at the second stage — 46.59% (p < 0.00001). For complicated rectal cancer: 1.03%, 1.6%, and 16.49%, respectively (p = 0.00402). The main factors that had an unsatisfactory effect on overall survival: surgery type — one-stage and multi-stage with tumor removal at the first stage (risk ratio (RR) 1.34; 95% coincidence interval (CI) 1.17–1.56; p < 0.0001); tumor perforation (OR 1.46, 95% CI: 1.36–1.55; p < 0.0001); disease stage (OR 1.61, 95% CI: 1.45–1.69; p < 0.0001), tumor site (OR 1.24, 95% CI: 1.29–1.72; p = 0.004); tumor histological type — poorly differentiated adenocarcinoma (OR 1.5, 95% CI: 1.24–1.62; p < 0.0001), the number of lymph nodes examined < 12 (OR 0.69, 95% CI: 0.59–0.63; p < 0.0001), presence of positive resection margins (R1 and/or CRM+) (OR 1.29, 95% CI: 1.14–1.47; p < 0.0001); severe comorbidity (OR 1.95, 95% CI: 1.62–1.98; p = 0.003), no adjuvant treatment (OR 0.57, 95% CI: 0.49–0.63; p < 0.0001).CONCLUSION: staged procedures with a minimal volume in an emergency and the second — main stage, performed in a specialized hospital, are the most appropriate in patients ≥ 70 years old.