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Prediction of Postoperative Mortality in Elderly Patients With Colorectal Cancer

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Diseases of the Colon & Rectum

Purpose

This study was designed to develop a model for predicting postoperative mortality in elderly patients undergoing surgery for colorectal cancer.

Methods

This multicenter study was conducted by using routinely collected clinical data, assessing patients older than aged 80 years, with 30-day operative mortality as the primary end point. Data were collected from The Association of Coloproctology of Great Britain and Ireland database, encompassing 8,077 newly diagnosed colorectal cancer patients undergoing resectional surgery in 79 hospitals between April 2000 to March 2002, The Association of Coloproctology Malignant Bowel Obstruction Study, encompassing 1,046 patients with malignant bowel obstruction in 148 hospitals, between April 1998 to March 1999, and The Wales-Trent audit, encompassing 3,522 newly diagnosed colorectal cancer patients, between July 1992 to June 1993. A multilevel logistic regression model was developed to adjust for case-mix and to accommodate the variability of outcomes between the three study populations. The model was internally validated using a Bayesian resampling technique and tested using measures of discrimination, calibration, and subgroup analysis.

Results

A total of 2,533 patients satisfied the inclusion criteria, with a 30-day mortality of 15.6 percent. Multivariate analysis identified the following independent risk factors: age (odds ratio for 85–90, 90–95, >95 vs. 80–85 = 1.1, 1.8, 2.9), American Society of Anesthesiology grade (odds ratio for Grade III, IV vs. I–II = 2.7, 6.1), operative urgency (odds ratio for emergency vs. elective = 1.9), no cancer excision vs. resection (odds ratio = 1.2), and metastatic disease (odds ratio for metastases vs. no metastases = 1.9). The model offered adequate discrimination (area under receiver operator curve = 0.732) and excellent agreement between observed and predicted outcomes during eight colorectal procedures (P = 0.885).

Conclusions

The elderly colorectal cancer model can accurately estimate 30-day mortality in patients older than aged 80 years undergoing surgery for colorectal cancer. Because the mortality can be considerable, this may have important implications when determining management for this group of patients.

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References

  1. D Etzioni J Liu M Maggard C Ko (2003) ArticleTitleThe aging population and its impact on the surgery workforce Ann Surg 238 170–177 Occurrence Handle12894008 Occurrence Handle10.1097/00000658-200308000-00003

    Article  PubMed  Google Scholar 

  2. Health expectancy. Living longer, more years in poor health. In: National Statistics on line. Available at: http://www.statistics.gov.uk. Accessed June 2004.

  3. Cancer Statistics registrations. England and Wales. London: Great Britain Office for National Statistics; 1992. Available at: http://www.cancerresearchuk.org. Accessed 30 October 2004.

  4. T Irvin (1988) ArticleTitlePrognosis of colorectal cancer in the elderly Br J Surg 75 419–421 Occurrence Handle3390669 Occurrence Handle1:STN:280:DyaL1c3mvF2luw%3D%3D

    PubMed  CAS  Google Scholar 

  5. H Tomoda S Tsujitani M Furusawa (1988) ArticleTitleSurgery for colorectal cancer in elderly patients: a comparison with younger adult patients Jpn J Surg 18 397–402 Occurrence Handle3172581 Occurrence Handle1:STN:280:DyaL1M%2Fht1Khug%3D%3D

    PubMed  CAS  Google Scholar 

  6. J Smith J Lee C Burke P Dawson (2002) ArticleTitleMajor colorectal cancer resection should not be denied to the elderly Eur J Surg Oncol 28 661–666 Occurrence Handle12359205 Occurrence Handle1:STN:280:DC%2BD38vpslyluw%3D%3D Occurrence Handle10.1053/ejso.2002.1265

    Article  PubMed  CAS  Google Scholar 

  7. J Goodwin J Samet W Hunt (1996) ArticleTitleDeterminants of survival in older cancer patients J Natl Cancer Inst 88 1031–1038 Occurrence Handle8683633 Occurrence Handle1:STN:280:DyaK28zhtlSktw%3D%3D

    PubMed  CAS  Google Scholar 

  8. InstitutionalAuthorNameColorectal Cancer Collaborative Group (2000) ArticleTitleSurgery for colorectal cancer in elderly patients: a systematic review Lancet 356 968–974 Occurrence Handle10.1016/S0140-6736(00)02713-6

    Article  Google Scholar 

  9. R Waldron I Donovan J Drumm S Mottram S Tedman (1986) ArticleTitleEmergency presentation and mortality from colorectal cancer in the elderly Br J Surg 73 214–216 Occurrence Handle3947921 Occurrence Handle1:STN:280:DyaL287jt1CjtQ%3D%3D

    PubMed  CAS  Google Scholar 

  10. J Samet W Hunt C Key C Humble J Goodwin (1986) ArticleTitleChoice of cancer therapy varies with age of the patient JAMA 255 3385–3390 Occurrence Handle3712698 Occurrence Handle1:STN:280:DyaL283isl2gtQ%3D%3D Occurrence Handle10.1001/jama.255.24.3385

    Article  PubMed  CAS  Google Scholar 

  11. G Copeland D Jones M Walters (1991) ArticleTitlePOSSUM: a scoring system for surgical audit Br J Surg 78 355–360 Occurrence Handle2021856 Occurrence Handle1:STN:280:DyaK3M3hsFCnuw%3D%3D

    PubMed  CAS  Google Scholar 

  12. M Whiteley D Prytherch B Higgins P Weaver W Prout (1996) ArticleTitleAn evaluation of the POSSUM surgical scoring system Br J Surg 83 812–815 Occurrence Handle8696749 Occurrence Handle1:STN:280:DyaK28zjsVynsA%3D%3D

    PubMed  CAS  Google Scholar 

  13. W Knaus D Wagner E Draper et al. (1991) ArticleTitleThe APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalised adults Chest 100 1619–1636 Occurrence Handle1959406 Occurrence Handle1:STN:280:DyaK38%2FntVWrtg%3D%3D

    PubMed  CAS  Google Scholar 

  14. PP Tekkis JD Poloniecki MR Thompson JD Stamatakis (2003) ArticleTitleOperative mortality in colorectal cancer: prospective national study BMJ 327 1196–1201 Occurrence Handle14630754 Occurrence Handle10.1136/bmj.327.7425.1196

    Article  PubMed  Google Scholar 

  15. PP Tekkis R Kinsman MR Thompson JD Stamatakis (2004) ArticleTitleThe Association of Coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer Ann Surg 240 76–81 Occurrence Handle15213621 Occurrence Handle10.1097/01.sla.0000130723.81866.75

    Article  PubMed  Google Scholar 

  16. J Mella A Biffin A Radcliffe J Stamatakis R Steele (1997) ArticleTitlePopulation-based audit of colorectal cancer management in two UK health regions Br J Surg 84 1731–1736 Occurrence Handle9448628 Occurrence Handle1:STN:280:DyaK1c7htVSkug%3D%3D Occurrence Handle10.1046/j.1365-2168.1997.02869.x

    Article  PubMed  CAS  Google Scholar 

  17. The National Bowel Cancer Project. Colorectal Cancer Dataset forms. Available at: http://www.nbocap.org.uk/docs/. Accessed June 2004.

  18. Department of Health. Hospital Episode Statistics, Main operations 2000/01; 2001.

  19. Then and Now. The 2000 Report of the National Confidential Enquiry into Perioperative Deaths. London: The Royal College of Surgeons of England, 2000.

  20. RJ Turnbull K Kyle F Watson J Spratt (1967) ArticleTitleCancer of the colon: the influence of the no-touch isolation technic on survival rates Ann Surg 166 420–427 Occurrence Handle6039601 Occurrence Handle10.1097/00000658-196709000-00010

    Article  PubMed  Google Scholar 

  21. J Rasbash W Browne H Goldstein (Eds) et al. (2001) A user's guide to MLwiN University of London London

    Google Scholar 

  22. D Hosmer S Lemeshow (2000) Applied logistic regression EditionNumber2nd ed. John Wiley & Sons New York

    Google Scholar 

  23. J Hanley B McNeil (1982) ArticleTitleThe meaning and use of the area under a receiver operating characteristic (ROC) curve Radiology 143 29–36 Occurrence Handle7063747 Occurrence Handle1:STN:280:DyaL387ltFyksQ%3D%3D

    PubMed  CAS  Google Scholar 

  24. H Jensen J Nielsen I Baslev (1970) ArticleTitleCarcinoma of the colon in old age Ann Surg 171 107–115 Occurrence Handle5409750 Occurrence Handle1:STN:280:DyaE3c%2FmsFOnsA%3D%3D

    PubMed  CAS  Google Scholar 

  25. M Hosking M Warner C Lobdell K Offord L Melton (1989) ArticleTitleOutcomes of surgery in patients 90 years of age and older JAMA 261 1909–1915 Occurrence Handle2926926 Occurrence Handle1:STN:280:DyaL1M7nvV2lsg%3D%3D Occurrence Handle10.1001/jama.261.13.1909

    Article  PubMed  CAS  Google Scholar 

  26. M Kourda G Sheldon (1991) ArticleTitleSurgery in the aged Adv Surg 24 293–331

    Google Scholar 

  27. P Sagar M Hartley B Mancey-Jones P Sedman J May J MacFie (1994) ArticleTitleCompararative audit of colorectal resection with the POSSUM scoring system Br J Surg 81 1492–1494 Occurrence Handle7820482 Occurrence Handle1:STN:280:DyaK2M7itVeqtQ%3D%3D

    PubMed  CAS  Google Scholar 

  28. M Coleman J Grabham D Bailey D Finnis (1996) ArticleTitleWessex colorectal cancer audit: emergency referrals Br J Surg 83 IssueIDSuppl 1 22

    Google Scholar 

  29. M Kruschewski N Runkel H Buhr (1998) ArticleTitleRadical resection in obstructing colorectal carcinomas Int J Colorectal Dis 13 247–250 Occurrence Handle9870170 Occurrence Handle1:STN:280:DyaK1M%2Fos12qtg%3D%3D Occurrence Handle10.1007/s003840050170

    Article  PubMed  CAS  Google Scholar 

  30. U Khot A Wenk Lang K Murali M Parker (2002) ArticleTitleSystematic review of the clinical evidence on colorectal self-expanding metal stents Br J Surg 89 1096–1102 Occurrence Handle12190673 Occurrence Handle1:STN:280:DC%2BD38vjsVWjug%3D%3D Occurrence Handle10.1046/j.1365-2168.2002.02148.x

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Imperial College London, Department of Surgical Oncology and Tehnology, St. Mary's Hospital, 10th Floor QEQM Wing, Praed Street, London, W2 1NY, United Kingdom

    Alexander G. Heriot M.D. & Paris P. Tekkis M.D., F.R.C.S.

  2. Department of Surgery, West Middlesex University Hospital, Isleworth, United Kingdom

    Jason J. Smith M.D.

  3. Department of Surgery, St. Mark's Hospital, London, United Kingdom

    C. Richard G. Cohen M.D.

  4. Department of Surgery, Queen Elizabeth Hospital, London, United Kingdom

    Andrew Montgomery M.D.

  5. Department of General Surgery, Whiston Hospital, Prescot, United Kingdom

    Riccardo A. Audisio M.D.

  6. Department of Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom

    Michael R. Thompson M.D.

  7. Department of Surgery, Princess of Wales Hospital, Bridgend, Wales, United Kingdom

    Jeffrey D. Stamatakis M.S.

Authors
  1. Alexander G. Heriot M.D.
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  2. Paris P. Tekkis M.D., F.R.C.S.
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  3. Jason J. Smith M.D.
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  4. C. Richard G. Cohen M.D.
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  5. Andrew Montgomery M.D.
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  6. Riccardo A. Audisio M.D.
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  7. Michael R. Thompson M.D.
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  8. Jeffrey D. Stamatakis M.S.
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Corresponding author

Correspondence to Paris P. Tekkis M.D., F.R.C.S..

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Heriot, A.G., Tekkis, P.P., Smith, J.J. et al. Prediction of Postoperative Mortality in Elderly Patients With Colorectal Cancer. Dis Colon Rectum 49, 816–824 (2006). https://doi.org/10.1007/s10350-006-0523-4

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  • DOI: https://doi.org/10.1007/s10350-006-0523-4

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