The impact of age on outcome after surgery for colorectal adenocarcinoma

INTRODUCTION

The incidence of colorectal cancer (CRC) increases with age. The aim of this study was to investigate the impact of age and age-related factors on post-operative mortality and survival following CRC resections.

METHODS

A prospectively collected database of 459 CRC resections was analysed.

RESULTS

The mean age of the patients was 70 years (range: 25–95 years) and 54% were male. The relative proportion of female patients increased with age so that for patients aged over 77 more women were treated than men. The probability of undergoing an emergency resection (25%) did not change with age. In older patients the proportion of rectal cancers resected decreased and the proportion of hemicolectomies and Hartmann''s operations performed increased. The 30-day mortality rate was 4% after elective and 11% after emergency resections. Most deaths were caused by medical complications, reflecting increased co-morbidity in the elderly. Post-operative mortality was 1% in patients under the age of 59. This increased by 3 percentage points every 10 years after elective resections and by 8 percentage points every 10 years after emergency resections. CRC-specific survival was independent of age whereas overall survival decreased so the likelihood of dying from CRC decreased with age: at age 50 half the deaths were from CRC, at age 70 a third and at age 80 a quarter.

CONCLUSIONS

CRC stage and the probability of presenting as an emergency did not change with age but older patients were more likely to be female and have colon cancer. Post-operative mortality progressively increased with age. Most deaths were caused by medical complications, reflecting increased co-morbidity. Older patients were less likely to die from CRC.     

The impact of bariatric surgery on colorectal cancer risk

Obesity is considered a risk factor for different types of cancer, including colorectal cancer (CRC). Bariatric surgery has been associated with improvements in obesity-related co-morbidities and reductions in overall cancer risk. However, given the contradictory outcomes of several cohort studies, the impact of bariatric surgery on CRC risk appears controversial. Furthermore, measurement of CRC biomarkers following Roux-en-Y gastric bypass (RYGB) has revealed hyperproliferation and increased pro-inflammatory gene expression in the rectal mucosa. The proposed mechanisms leading to increased CRC risk are alterations of the gut microbiota and exposure of the colorectum to high concentrations of bile acids, both of which are caused by RYGB-induced anatomical rearrangements. Studies in animals and humans have highlighted the similarities between RYGB-induced microbial profiles and the gut microbiota documented in CRC. Microbial alterations common to post-RYGB cases and CRC include the enrichment of pro-inflammatory microbes and reduction in butyrate-producing bacteria. Lower concentrations of butyrate following RYGB may also contribute to an increased risk of CRC, given the anti-inflammatory and anticarcinogenic properties of this molecule. Laparoscopic sleeve gastrectomy appears to have a more moderate impact than RYGB; however, relatively few animal and human studies have investigated its effects on CRC risk. Moreover, evidence regarding the impact of anastomosis gastric bypass on one is even more limited. Therefore, further studies are required to establish whether the potential increase in CRC risk is restricted to RYGB or may also be associated with other bariatric procedures.     

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目的探讨高龄结、直肠癌病人并存病的围手术期处理。方法回顾性分析1996年1月至2000年7月间收治65例70岁以上有并存病的结、直肠癌病人的外科治疗？结果并存心脏病40例，高血压17例，糖尿病13例，呼吸系统疾病13例，贫血26例，低蛋白血症41例。术后并发症有肠瘘2例，伤口裂开2例、伤口感染8例，肺部感染3例，心功能不全1例。围手术期死亡2例。结论虽然并存病增加了手术风险，但术前全面了解病情，加强并存病的围手术期处理可大大提高手术成功率，降低手术死亡率和并发症发生率。     

Delay in detection and treatment of perioperative anemia in hip fracture surgery and its impact on postoperative outcomes

BackgroundElderly patients with hip fractures are at high risk for perioperative anemia as a result of fracture- and surgery-related blood loss. The detection of anemia is dependent on intermittent blood samples and therefore might be delayed, potentially leading to a significant delay in transfusion. This study aimed to investigate the possible delay in perioperative anemia detection, accumulated perioperative anemia-associated burden, peripheral perfusion, and their association with patient outcomes in elderly patients with hip fracture.MethodsElderly patients with acute hip fracture scheduled for surgery were enrolled in this prospective study from August 2016 to December 2016. All patients were monitored continuously for hemoglobin concentration (SpHb) and perfusion index (PI) with the Radical-7® Pulse CO-Oximeter® and Rainbow® R1 Adhesive Multi-parameter Sensors (Masimo Corp., Irvine, CA, US) from 12 h presurgery to 24 h postsurgery.ResultsFifty-one patients were enrolled, and 41 were included in the final analyses. Mean delay in the detection of low Hb (<10 g/dL) using intermittent blood samples, when compared with SpHb, was 1.07 h (standard deviation, ±2.84 h). Median perioperative cumulated time with low SpHb (<10 g/dL for at least one min) was 25 min (interquartile range [IQR]: 21–690). There was a significant association between perioperative time with low SpHb and the occurrence of postoperative delirium (median cumulated time with low SpHb: 162 min in patients with delirium vs 22 min in patients without delirium, P = 0.034) and a nonsignificant trend for an association between perioperative time with low SpHb and 90-day mortality or medical complications (median cumulated time with low SpHb: 119 min for patients with mortality or severe complication vs 22 min for patients without mortality or severe complication, P = 0.104). PI values during the perioperative period were not significantly associated with patient outcomes. Cumulated time with low PI (<0.5) preoperatively (but not perioperatively) was significantly associated with the occurrence of postoperative delirium (P = 0.047).ConclusionsThis study showed a delay in transfusion threshold detection, and the presence of significant associations between low SpHb or time with low SpHb and postoperative outcomes.     

Esophagectomy for carcinoma: impact of age on clinical results and survival

Advances in perioperative management have allowed more and more elderly patients to undergo major surgery with postoperative morbidity and mortality rates similar to those of younger individuals. The aim of this study was to evaluate the impact of age on the clinical outcome and long-term survival of patients with oesophageal cancer undergoing oesophagectomy. Eight hundred and seventy-five patients with oesophageal carcinoma were divided into two groups: A (n = 393) aged > or = 65 years, and B (n = 482) aged < 65 years. One hundred and forty-nine (38%) patients in group A underwent surgery compared to 263 (55%) in group B (P < 0.01). Postoperative mortality and the prevalence of anastomotic leak and respiratory complications were similar in both groups. There was, however, a higher prevalence of cardiovascular complications in group A (13% versus 3%, P < 0.01). Five-year survival was about 35% in both groups. In conclusion, advanced age should not be considered a contra-indication to oesophagectomy for carcinoma, since the long-term survival of elderly patients undergoing resection is similar to that of younger ones.     

The impact of hypertension on the operative and early postoperative outcome of aortic valve surgery

Hypertension is a known risk factor in heart disease. It can lead to pressure overload and hypertrophy of the left ventricle. The aim of this study is to examine the effect of hypertension on the operative and early postoperative outcome after aortic valve surgery using the retrograde cardioplegia.All the data of all the patients who had aortic valve surgery in our department were retrospectively examined during the period from January 1994 until April 1996 and received retrograde blood cardioplegia. 397 patients were included in this study. 213 of them had arterial hypertension, as preoperatively diagnosed by the referring cardiologist. There were 163 females and 234 males. 142 were above 70 yr of age. 22 patients had an ejection fraction (EF) < or =0.4 and in 168 patients the LVEDP was >15 mmHg. Hypertension alone proved to be no risk factor. Decreased EF in hypertensive patients leads to an increase in the occurrence of prolonged ICU-stay, low cardiac output and neurological complications. Hypertension alone does not increase the risk of operative and early postoperative aortic valve surgery.     

The changing impact of age on colorectal cancer surgery. A trend analysis

Objective  The aim of the study was to evaluate the changing influence of age on the outcomes of colorectal cancer surgery in a retrospective trend analysis.
Methods  Data on 985 patients undergoing colorectal cancer surgery were collected during 1975–1984 and 1995–2004. Variables and outcomes of patients aged < 65, 65–74, 75–84 and 85+ years were compared with intra- and interdecade analyses. Endpoints of the study were postoperative mortality, 5-year overall and cancer-related survivals.
Results  The rate of elderly patients undergoing colorectal cancer surgery increased significantly from 1975–1984 to 1995–2004. Distribution of American Society of Anesthesiology score and cancer stage remained unchanged over time. The rate of palliative procedures decreased over time, most significantly in the older age groups. In 1995–2004 the palliation rate was similar across all age groups. The rate of emergency surgery also decreased, but it remained higher in older age groups. Operative mortality rate decreased over time across all age groups, but age-related differences were still observed in the 1995–2004 series. Cancer-related survival after curative surgery increased from 58% in 1975–1984 to 64% in 1995–2004 in 75+ years patients, while it increased from 56% to 78% in patients aged 74 years or younger.
Conclusions  Elderly patients with colorectal cancer benefited substantially from healthcare progress during the last 30 years. The reduction of palliative procedures and the decline in operative mortality document the efficacy of not restricting the access to radical surgery for these patients.     

Clinical significance of perioperative hyperglycemia in bariatric surgery: evidence for better perioperative glucose management

Background

Uncontrolled hyperglycemia in patients undergoing surgery has been shown to be a risk factor for postoperative complications.

血小板衍化内皮细胞生长因子在结直肠癌中的表达及意义

目的　研究血小板衍化内皮细胞生长因子(Platelet derivedEndothelialCellGrowth Factor,PD ECGF)在结直肠癌中的表达与结直肠癌的病理及临床分期的关系。方法　应用免疫组 化技术对33例结直肠癌组织进行PD ECGF表达、增殖指数(PI)及肿瘤组织微血管密度(MVD)检 测。结果　PD ECGF的表达与结直肠癌的Dukes分期(P<0.05)、组织分化程度(P<0.05)及淋巴 结转移(P<0.05)有相关性,与结直肠癌PCNA指数(PI)(P<0.01)和MVD(P<0.01)有显著相关 性。MVD和PI与结直肠癌淋巴结转移和组织分化程度有相关性(P<0.05)。结论　结直肠癌组织 中的PD ECGF可促进微血管生成,促进结直肠癌的增殖和转移,可作为反映结直肠癌生物学行为及 预后监测指标之一。     

Relevance of age and preoperative risk in laparoscopic colorectal surgery

Summary   Background: We assessed the outcome of various laparoscopic colorectal procedures according to different ages and risk groups. Methods: The results of 25 patients under 70 years (Group I) were compared with the results of 26 patients, 70 years and older (Group II). Both groups were matched for gender, indications for surgery and operative procedures. Results: The preoperative risk was significantly higher in Group II, in which 77 % of patients corresponded to ASA III compared to 28 % in Group I, p≤0.001. A significant smaller number of preoperative blood transfusions was required in Group II, p≤0.01. No significant differences were found between Group I and Group II due to conversion rate (16 % vs. 4 %), complications (16 % vs. 27 %) and reoperation rate (12 % for both). Postoperative mortality was only slightly higher in Group II (3/12 %), compared to Group (1/4 %). 2 of 3 exitus in Group II were related to cardiopulmonary complications. Concerning fast postoperative recovery, analgesics consumption and first bowel movement were similar for both groups. Conclusions: Compared to younger patients the elderly can benefit from laparoscopic colorectal techniques as well. However they must be carefully selected with respect to their preoperative risk and associated comorbidity.      

微小RNA在结直肠癌中的表达及其临床意义

结直肠癌是个多因素、多步骤,并同多种基因相关联所致的疾病。近年来研究表明微小RNA(miRNA)在基因表达调控方面与结直肠癌的发病率密切相关,miRNA可以通过靶基因调控蛋白,同时,这些受其调控的蛋白也能反过来调控miRNA的表达,从而在体内形成了一个复杂的调控网络,在肿瘤的发生发展过程中起到重要的作用。在这里,我们主要讨论miRNA作为肿瘤标记物在结直肠癌早期诊断、评估预后中以及指导治疗中的潜在用途。     

结直肠癌微血管密度与生物学行为及预后相关性研究

目的：探讨微血管密度（MVD）与结直肠癌淋巴结转移及预后的相关性及其临床意义。方法：应用免疫组化S－P法,以Ⅷ因子相关抗原作为血管内皮细胞标记物测定其微血管密度。结果：59例结直肠癌中,淋巴结转移组MVD高表达,无淋巴结转移组MVD低表达（P＜0．05）。MVD低表达组5年生存率明显高于MVD高表达组（P＜0．05）。33例患术中施行门脉插管术后接受5－Fu治疗,5年生存率MVD低表达组与MVD高表达组无统计学差异（P＞0．05）。术后未加辅助治疗26例,5年生存率MVD低表达组明显高于MVD高表达组（P＜0．05）。结论：MVD表达与结直肠癌的生物学行为及预后密切相关,检测MVD在判断结直肠癌患的预后方面有重要意义。     

The impact of colonoscopy on colorectal carcinoma

In an eight-year, ongoing study of 120 patients, 39 with carcinomas and 81 with adenomas, no patient has produced a new carcinoma despite a high incidence of metachronous adenomas. Colonoscopy can identify early carcinomas that can be resected for cure. In addition, colonoscopy can identify the adenomatous polyps and with polypectectomy prevent the progression to carcinoma. Colonoscopy is more accurate than air contrast barium enema, provides a tissue diagnosis, and allows polypectomy. When applied according to risk factors known to be cost effective, colonoscopy leads to earlier diagnosis and thus improved long-term survival.     

Surgical treatment for gastric cancer in Turkish patients over age 70: early postoperative results and risk factors for mortality

Purpose

The aim of this study was to evaluate the effects of advanced age on early postoperative results and to investigate risk factors for mortality in Turkish gastric cancer patients.

Methods

From 2002 to 2007, 549 patients who underwent gastrectomy for gastric cancer were divided into two groups as patients younger than 70 years and patients aged 70 years or older.

Results

There were 387 patients in the younger group and 162 in the older group. Morbidity rates were similar (25.1% vs. 29.0%). Mortality was higher among the elderly patients (2.6% vs. 9.9%). Advanced age, albumin levels lower than 3 mg/dl, higher American Society of Anesthesiologists score, palliative resections and resection of two or more additional organs were independent risk factors for mortality.

Conclusion

Age alone should not preclude gastric resection in elderly patients. However, for patients with multiple risk factors, more limited surgery should be considered.     

Reduction of prolonged postoperative hospital stay after laparoscopic surgery for colorectal carcinoma

Background In evaluating the quality of laparoscopic surgery (LS) for colorectal carcinoma, many previous reports have used median or range values to assess the length of postoperative hospital stay and to show the complication and conversion rates separately. However, with this method, it is impossible to assess the proportion of patients who required prolonged postoperative hospital stay because of perioperative morbidities. This study investigated the proportion of patients who benefited from LS as minimally invasive surgery by assessing the percentage of patients who required prolonged postoperative hospital stay because of major perioperative morbidities. Methods A review of 202 patients who underwent LS for colorectal carcinoma at the authors’ hospital between January 2002 and December 2004 was performed. Short-term outcomes were compared among the patients who underwent LS in 2002, 2003, and 2004. Results No significant differences were observed in baseline characteristics among the groups, and all the procedures in this study were completed laparoscopically. There were no significant differences in the operative times and intraoperative blood losses among the groups. Most of the patients resumed liquid intake on postoperative day 1 and solid food on day 3. However, there was a significant difference in the rate of postoperative prolonged hospital stays by year of surgery. In 2004, 97.3% of the patients (72/74) undergoing LS could be discharged to home within 8 days postoperatively. Major complications occurred at a low rate of 1.4% (1/74) in 2004. Regarding the reasons for prolonged postoperative hospital stay, inappropriate judgment of the physician in charge, based primarily on requests from patients without medical necessity, disappeared in 2004. Conclusions When LS is performed properly by specialists who have accumulated sufficient experience in both LS and conventional open surgery for colorectal carcinoma, up to 97% of patients undergoing LS can benefit from minimally invasive surgery.     

Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results

apd: 12 December 2000     

周期蛋白A在大肠癌中的表达及其意义

目的　探讨细胞周期蛋白 (cyclin)A在大肠癌中的表达及临床意义。方法　采用免疫组织化学方法检测不同年龄和分期患者的癌组织、癌旁黏膜及正常黏膜中cyclinA的表达。 结果　 (1) 79例标本癌组织中cyclinA表达的阳性率为 70 .9% ;癌旁黏膜阳性率为 5 .1% ;正常黏膜中均未见表达 ,癌旁黏膜及正常黏膜中cyclinA的表达均与癌组织比较差异有显著性 (P <0 .0 1)。(2 )cyclinA的表达在患者不同年龄、肿瘤大小、组织学类型、浸润深度之间差异有显著性 (P <0 .0 5 )。结论　cyclinA的过表达是大肠癌发生的早期事件 ,是影响大肠黏膜细胞正常细胞周期的重要途径之一     

Elevated preoperative C-reactive protein levels are a risk factor for the development of postoperative infectious complications following elective colorectal surgery

Purpose

The present study was designed to evaluate the relationship between the preoperative C-reactive protein levels and the incidence of postoperative infectious complications in patients undergoing colorectal surgery.

Methods

This study was a retrospective cohort study of a consecutive series of 464 patients who underwent elective colorectal resection between April 2010 and March 2012. We evaluated the patients’ preoperative conditions, including the preoperative C-reactive protein levels, surgical content, and incidence of postoperative infectious complications.

Results

Postoperative infectious complications occurred in 133 patients (28.7 %). In the univariate analysis, male gender, rectal surgery, open surgery, elevated preoperative white blood cell counts, elevated preoperative C-reactive protein levels, extended operative times, large amounts of blood loss during surgery, and ostomy formation were found to be significantly associated with the incidence of postoperative infectious complications. In the multivariate analysis, elevated preoperative C-reactive protein levels (OR per mg/dl?=?1.17, 95 % CI?=?1.02–1.37, P?=?0.02) and large amounts of blood loss during surgery (OR per 100 g?=?1.13, 95 % CI?=?1.06–1.23, P?<?0.01) were found to be independently associated with the incidence of postoperative infectious complications.

Conclusions

This study provides evidence of an association between the preoperative C-reactive protein level and the incidence of postoperative infectious complications following colorectal surgery, which should be further confirmed in prospective and appropriately designed studies.