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Long-term outcomes in elderly patients after elective surgery for colorectal cancer within an ERAS protocol: a retrospective analysis

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Abstract

Purpose

The number of elderly patients with a diagnosis of colorectal cancer (CRC) is increasing. Considering short life expectancy and multiple comorbidities, surgery may not always be the best treatment option.

Methods

We included all consecutive patients aged 80 years and older who underwent elective resection for CRC following Enhanced Recovery after Surgery (ERAS) protocol between January 2011 and May 2021. The primary endpoint was overall survival, secondary endpoints were 30-day morbidity, and the rate of return to pre-operative living conditions 3 months after surgery.

Results

Ninety-four patients were included. Mean age was 84.6 ± 3.6 years, 49 patients (52%) were female. Most patients (77.6%) were ASA score ≥ 3. Laparoscopic resections were performed in 85 patients (90.4%), involving 69 (73.4%) colonic and 25 (26.6%) rectal resections. A stoma was constructed in 22 patients (23%), and reversed in 12 (54.5%). Twenty-two patients (23.4%) experienced a Clavien-Dindo ≥ 3 complication, and 2 patients (2.1%) died. The median length of hospital stay was 8 (interquartiles: 6–15) days. Sixty-six patients (70.2%) were discharged home directly and 26 (27.7%) to rehabilitation or postacute care institutes. At three months after surgery, eighty-two patients (96.5%) returned to their pre-operative living conditions directly or after short-term rehabilitation. Mean follow-up was 53 ± 33 months, estimated 5-year overall survival was 60.3% (95%CI 49.5–71.1%), and disease-free survival was 86.3% (95%CI 78.1–94.4%).

Conclusions

Our study suggests that elderly patients undergoing elective surgery have a high potential to return to preoperative living conditions and good overall- and disease-free survivals, despite significant postoperative morbidity.

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Fig. 1
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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. University of Lausanne, Quartier Centre, 1015, Lausanne, Switzerland

    Andrea Navarra & Fabian Grass

  2. Department of Surgery, Ospedale Regionale Di Lugano, EOC, Via Tesserete 46, 6900, Lugano, Switzerland

    Iride Porcellini, Sotirios Georgios Popeskou & Dimitri Christoforidis

  3. Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, EOC, Via Ospedale 12, 6500, Bellinzona, Switzerland

    Francesco Mongelli

  4. Faculty of Biomedical Science, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland

    Francesco Mongelli & Dimitri Christoforidis

  5. Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Fabian Grass & Dimitri Christoforidis

Authors
  1. Andrea Navarra
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  2. Iride Porcellini
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  3. Francesco Mongelli
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  4. Sotirios Georgios Popeskou
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  5. Fabian Grass
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  6. Dimitri Christoforidis
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Contributions

Study conception and design: all authors. Data acquisition: Andrea Navarra, Iride Porcellini. Analysis and interpretation of data: Francesco Mongelli, Sotirios Georgios Popeskou, Fabian Grass, Dimitri Christoforidis. Drafting of manuscript: Iride Porcellini, Andrea Navarra, Sotirios Georgios Popeskou, Francesco Mongelli. Critical revision of manuscript: Fabian Grass, Dimitri Christoforidis.

Corresponding author

Correspondence to Francesco Mongelli.

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Competing interests

The authors declare no competing interests.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local ethics committee (Comitato Etico Cantonale Ticino number 2021–02121 CE 3973). Informed consent and consent to publish were obtained from all individual participants included in the study.

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Drs. Andrea Navarra and Iride Porcellini contributed equally to this work and share first authorship.

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Navarra, A., Porcellini, I., Mongelli, F. et al. Long-term outcomes in elderly patients after elective surgery for colorectal cancer within an ERAS protocol: a retrospective analysis. Langenbecks Arch Surg 408, 438 (2023). https://doi.org/10.1007/s00423-023-03179-7

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  • DOI: https://doi.org/10.1007/s00423-023-03179-7

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