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Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer

Abstract

Background

The proportion of elderly colorectal cancer (CRC) patients requiring surgery is increasing. Colorectal resection for left-sided cancers is the most controversial as the primary anastomosis or end-colostomy and open or minimally invasive approaches are available. Therefore, this study was conducted to investigate the short- and long-term outcomes in elderly patients after resection with primary anastomosis for left-sided CRC.

Methods

The cohort study included left-sided colorectal cancer patients who underwent resection with primary anastomosis. The participants were divided into non-elderly (≤75 years) and elderly (> 75 years) groups. Short- and long-term postoperative outcomes were investigated.

Results

In total 738 (82%) and 162 (18%) patients were allocated to non-elderly and elderly groups, respectively. Minimally invasive surgery (MIS) was less prevalent in the elderly (42.6% vs 52.7%, p = 0.024) and a higher proportion of these suffered severe or lethal complications (15.4% vs 9.8%, p = 0.040). MIS decreased the odds for postoperative complications (OR: 0.41; 95% CI: 0.19–0.89, p = 0.038). The rate of anastomotic leakage was similar (8.5% vs 11.7%, p = 0.201), although, in the case of leakage 21.1% of elderly patients died within 90-days after surgery. Overall- and disease-free survival was impaired in the elderly. MIS increased the odds for long-term survival.

Conclusions

Elderly patients suffer more severe complications after resection with primary anastomosis for left-sided CRC. The risk of anastomotic leakage in the elderly and non-elderly is similar, although, leakages in the elderly seem to be associated with a higher 90-day mortality rate. Minimally invasive surgery is associated with decreased morbidity in the elderly.

Peer Review reports

Introduction

Colorectal cancer (CRC) is a major health care issue as it is the third most deadly and fourth most commonly diagnosed cancer worldwide [1]. Surgery remains the only potentially curative treatment option for it [2]. As society is aging in many developed countries, the proportion of elderly patients requiring surgery for CRC is increasing as well [3, 4]. Despite improvements in perioperative care and surgical techniques, the treatment of elderly CRC patients remains challenging because of comorbidities, frailty, malnutrition, impaired functional, and cognitive status [5,6,7,8]. Such complex patients are at higher risk for various postoperative complications after major surgery, including a higher risk for infectious complications and anastomotic leakage (AL) [9,10,11,12]. Furthermore, elderly patients are at higher risk for death in case of postoperative complications because of the impaired functional reserve [13, 14]. These risks usually impact the surgeon’s decision on the surgical plan, especially for elderly patients with left-sided CRC where Hartmann’s procedure may be selected instead of primary anastomosis [15, 16]. Further, advanced age had initially been viewed as a relative contraindication to laparoscopic surgery [17], and minimally invasive surgery (MIS) is still underutilized in the elderly [18]. Since elderly patients are significantly underrepresented in the clinical studies due to careful participant selection by common age, performance status, or comorbidities restrictions [19, 20], there is a lack of evidence for the most appropriate surgical strategies in such patients. Therefore, this study was conducted to investigate the short- and long-term outcomes after resection with primary anastomosis for left-sided CRC in elderly patients, with a special focus on the rate of AL and utilization of MIS.

Materials and methods

Ethics

The study was approved by Vilnius Regional Bioethics Committee (Approval number 2019/3–116-608) and conducted according to the Declaration of Helsinki of 1964, as revised in later versions.

Patients and study design

This retrospective cohort study included all patients who underwent elective colorectal resection with primary anastomosis at two major gastrointestinal cancer treatment centers in Lithuania – National Cancer Institute and Vilnius University hospital Santaros Klinikos between January 2014 and December 2018. Patients were divided into non-elderly (NE; ≤75 years) and elderly groups (E; > 75 years) according to the age at the time of surgery.

Data collection

The database used for the present study was used previously [12]. All patients’ characteristics and clinical data were obtained from the medical records and prospectively collected databases. The preoperative data included: age, gender, body mass index (BMI), Charlson comorbidity index (CCI), comorbidities, American Society of Anesthesiology (ASA) score, type of neoadjuvant treatment, tumor localization. Chronic kidney failure was defined as a kidney damage or glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 for 3 months or more, irrespective of cause as proposed by Kidney Disease: Improving Global Outcomes (KDIGO) [21]. Intraoperative details included: type of surgery, the approach of surgery (open or minimally invasive), operation time, blood loss, the height of anastomosis measured from the anal verge, presence of diverting ileostomy. Standard laparoscopic colorectal resection, hand-assisted laparoscopic surgery, natural orifice specimen extraction surgery, and transanal total mesorectal excision operations were defined as minimally invasive approaches. Postoperative data included histological report results, hospitalization time, postoperative complications graded by Clavien-Dindo classification, 30-day, and 90-day mortality rates. The tumor stage was set according to the TNM system as described at the American Joint Committee on Cancer 8th edition.

Study outcomes

The primary outcome of the study was the anastomotic leakage rate in NE and E patients. The secondary outcomes were overall postoperative morbidity rate; in-hospital, 30-day, and 90-day mortality rates; the rate of MIS; overall survival (OS), and disease-free survival (DFS) rates in NE and E patients. OS was defined as the time from surgery to death. DFS was defined as the time from surgery to disease progression including local or distant recurrence or death. Data on survival and date of death were collected from the National Lithuanian Cancer registry.

Statistical analysis

All statistical analyses were performed using SPSS version 25.0 software (SPSS, Chicago, IL, USA). Continuous variables between groups were compared by Student’s t-test or Mann– Whitney U-test depending on data distribution and expressed as mean ± standard deviation (±SD) or median with first (Q1) and third (Q3) quartiles. Categorical variables were compared by χ2 test or Fisher’s exact test and expressed as proportion and percentages. Missing data was not handled at the statistical analysis and no imputation techniques were used. To determine the risk factors for anastomotic leakage, all potential risk factors were included in univariate analyses. These variables which showed significance were included in subsequent multivariable analysis. Kaplan-Meier method was used for OS and DFS analysis and curves were compared by the log-rank test. Multivariable survival analysis was performed using the Cox proportional hazards model (hazard ratio and 95% confidence intervals). Statistical significance was assumed for p values < 0.05.

Results

Patients baseline characteristics

A total of 900 patients were included in this study. Seven hundred thirty-eight (82%) patients were allocated to the NE group (≤75 years) and 162 (18%) patients were allocated to the E group (> 75 years). Baseline clinical characteristics of the study patients are presented in Table 1. E patients had higher ASA and CCI scores, but a lower proportion of these was obese (Table 1).

Table 1 Baseline clinical characteristics of non-elderly and elderly patients

Intraoperative and postoperative outcomes

Intraoperative and postoperative outcomes are shown in Table 2. Lower proportion of E patients received MIS (52.7% vs 42.6%, p = 0.024). There was some tendency for a higher postoperative morbidity rate in the E (37.0%) group compared to NE (29.7%) group, however, the difference failed for significance (p = 0.066). Although, severe or lethal complications by Clavien-Dindo score III-V were more common in the E group (15.4% vs 9.8%, p = 0.040).

Table 2 Intraoperative and postoperative outcomes of non-elderly and elderly patients after resection with primary anastomosis for left-sided colorectal cancer

Anastomotic leakage in the study cohort

Eighty-two of 900 (9.1%) patients included in the study developed AL. Male gender, higher CCI score (> 5), advanced pT stage (pT3–4), lower anastomoses, and open surgery were associated with AL in the univariate analysis (Table 3). The rate of AL was similar between NE (8.5%) and E (11.7%) groups, p = 0.201. Although, there was some tendency for increased 90-days mortality in E patients who developed AL, but without statistical significance (6.3% vs 21.1%, p = 0.079). Variables that showed significance in univariate analysis were included in subsequent multivariable analysis. Male gender (OR: 1.94; 95% CI: 1.15–3.29, p = 0.013), CCI score > 5 (OR: 1.90; 95% CI: 1.14–3.16, p = 0.013), and anastomoses at 6–12 cm from anal verge (OR: 2.29; 95% CI: 1.24–4.21, p = 0.008) were identified as a risk factor for AL (Table 4).

Table 3 Univariate analysis of risk factors for anastomotic leakage in patients after resection with primary anastomosis for left-sided colorectal cancer
Table 4 Multivariable analysis of risk factors for anastomotic leakage in patients after resection with primary anastomosis for left-sided colorectal cancer

Factors associated with postoperative morbidity in the subgroup of elderly patients

Since the E patients were at higher risk for postoperative morbidity and mortality, the univariate analysis was performed to identify the variables associated with postoperative complications in the subgroup of E patients. Open surgery was the only risk factor associated with postoperative complications in the univariate setting (Table 5).

Table 5 Univariate analysis of risk factors for postoperative complications in elderly patients after resection with primary anastomosis for left-sided colorectal cancer

Survival

The median time to follow-up was 38 (Q1: 22; Q3: 53) months. Overall and disease-free survival was significantly lower in E patients (Figs. 1 and 2). The multivariable Cox proportional hazards model was performed to identify the factors associated with OS and DFS in the E group. E patients who received MIS had higher probability for OS (HR: 0.47; 95% CI: (0.25–0.86), p = 0.015) and DFS (HR: 0.48; 95% CI: (0.27–0.86) (Table 6).

Fig. 1
figure 1

Overall survival in non-elderly and elderly patients who received colorectal resection with primary anastomosis for left-sided colorectal cancer

Fig. 2
figure 2

Disease-free survival in non-elderly and elderly patients who received colorectal resection with primary anastomosis for left-sided colorectal cancer

Table 6 Cox regression (multivariable) analysis for overall and disease-free survival in the elderly patients after resection with primary anastomosis for left-sided CRC

Discussion

The present study demonstrated the trend of a slightly higher rate of postoperative morbidity in the elderly patients after colorectal resection with the primary anastomosis for left-sided cancer. However, the rate of severe or lethal complications was undoubtedly higher in the elderly patients group. Interestingly, the rate of AL was similar across the study groups, but in the case of leakage elderly patients were at much higher risk for death within 90-days after surgery. The MIS was associated with reduced postoperative morbidity in the elderly; however, this approach was underutilized in these patients.

The reported rate of postoperative complications in elderly colorectal cancer patients varies between 26 and 53.7% [22,23,24], as our study showed a comparable rate of 37%. The elderly patients often have a higher ASA score [25,26,27], which is the risk factor for postoperative complications as shown in the present study and some previous reports [22]. It is not surprising, that the frequent presence of comorbidities, frailty and impaired functional reserves in the elderly leads to the increased postoperative morbidity and mortality [23, 28,29,30]. However, it remains unclear if elderly patients are at a higher risk for all types of complications or only specific ones. The particularly important question is whether the elderly patients are at higher risk for the AL, especially after resection for left-sided cancer. This has special importance, because, the higher rate of AL compared to right-side surgery [31] is preventable by utilizing Hartmann’s procedure. The current data on the risk of AL in elderly patients is inconclusive. Some studies suggest a higher risk because of co-existing medical conditions, which are known risk factors for AL, such as coronary heart disease and diabetes [27, 32, 33]. In contrast, the other series of previous studies identified a similar risk of AL in elderly and non-elderly patients [34,35,36,37]. The present study shows that the risk in elderly and non-elderly patients after resection for left-sided CRC is similar. However, it is necessary to note, that the consequences of leakage in the elderly were much more dramatic since the 90-day mortality rate exceeded 20%. Thus, we consider, that primary anastomosis after left-sided resection for CRC is feasible in the elderly, but these patients must be monitored closely, and in the case of AL the aggressive treatment of the complication is mandatory.

MIS is currently considered an excellent alternative for open CRC surgery since large-scale RCTs demonstrated improved short-term and similar long-term outcomes [38,39,40,41,42,43]. Furthermore, large-scale population-based studies show that MIS is associated with decreased morbidity and mortality in CRC patients [44, 45]. Despite such evidence, MIS is underutilized in elderly patients as demonstrated by this study. A similar pattern of slow and even decreasing adoption of laparoscopic CRC surgery in the elderly is observed not only in our cohort but in other Western countries as well [18]. The reasons for such disparities in implementing MIS for younger and elderly CRC patients remain unclear. Although, some controversies exist on this topic and they may be responsible for the reluctance to perform MIS in the elderly. First, MIS is associated with significantly longer operative time, therefore there is a long time of the patient under anesthesia. Second, the potential cardiopulmonary changes induced by pneumoperitoneum and prolonged patient positioning remains a concern. Third, the studies which proved the benefit of MIS in CRC patients underrepresented the elderly population. Thus, there is a background for some scepticism regarding MIS adoption in elderly. Although, several previous studies showed the favourable outcomes of MIS in elderly CRC patients [46,47,48,49,50]. Further, our study confirmed, that MIS is associated with lower odds for postoperative complications in elderly patients who undergo resection with primary anastomosis for left-sided cancer. Hence, surgeons should not avoid MIS in the elderly, because this high-risk population seems to receive a significant benefit from this technique.

In contrast to some previous reports [51, 52], we found impaired long-term outcomes in elderly patients after resection for left-sided CRC. The first 3 months after surgery were suggested as the most critical for these patients [51] and the results of the present confirmed the importance of the early postoperative period as 90-days mortality reached 7.4% in elderly and only 1.6% in younger counterparts. Such findings indicate the need for remarkably close monitoring of late postoperative complications and life-threatening events during the early postoperative period in elderly population undergoing colorectal resection. To our surprise, we found impaired DFS in elderly patients as well. There is no clear explanation for such a finding since there is no evidence for a more aggressive biological behaviour of CRC in the elderly. However, few patients and treatment-related may be responsible. At first, the most frail elderly patients do not receive adjuvant chemotherapy because of poor physical condition [53]. Second, elderly patients are at higher risk for postoperative complications, which are responsible for the delay of adjuvant chemotherapy [54], thus the impaired oncological outcomes [55]. Third, elderly patients, who receive adjuvant therapy, are at higher risk for dose de-escalation because of renal and liver dysfunctions [3]. For these reasons, successful surgical treatment with an uneventful postoperative course plays a key role in the management of CRC in this population. As the present study showed, the MIS is an excellent option for elderly patients since the lower odds for postoperative morbidity, recurrence of disease, and death.

Our study has several limitations. First, it is a retrospective cohort study, therefore it is subject to the biases and confounding factors linked to such methods of research. Moreover, missing data was not handled at the statistical analysis and no imputation techniques were used as missing rate of < 5% is considered inconsequential. Second, there was an unidentifiable bias in the decisions to perform open or MIS in elderly patients. It is possible that the choice was made in settings of surgeon experience and the patient’s global health status, thus, lower morbidity after MIS may be the consequence of the selection bias, rather than the real advantage of the method. Third, this study did not include any patient-reported outcomes, such as quality of life or others.

A strength of the current multi-center study includes a large sample size of the left-sided CRC patients who receive resection with primary anastomosis with long-term survival data.

Conclusions

Short- and long-term outcomes of elderly patients who underwent resections with primary anastomosis for left-sided CRC are impaired. The risk of anastomotic leakage in the elderly and non-elderly patients is similar, but leakages in the elderly seem to be associated with a higher 90-day mortality rate. Minimally invasive surgery is associated with decreased morbidity in the elderly and better long-term outcomes.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CRC:

Colorectal cancer

AL:

Anastomotic leakage

MIS:

Minimally invasive surgery

NE:

Non-elderly

E:

Elderly

BMI:

Body mass index

CCI:

Charlson comorbidity index

ASA:

American Society of Anesthesiology

OS:

Overall survival

DFS:

Disease-free survival

References

  1. Rawla P, Sunkara T, Barsouk A. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Przegla̜d Gastroenterol. 2019;14:89–103.

    CAS  Google Scholar 

  2. Kuipers EJ, Grady WM, Lieberman D, Seufferlein T, Sung JJ, Boelens PG, et al. Colorectal cancer. Nat Rev Dis Primer. 2015;1:15065.

    Google Scholar 

  3. Itatani Y, Kawada K, Sakai Y. Treatment of Elderly Patients with Colorectal Cancer. Biomed Res Int. 2018;2018:2176056.

  4. Fagard K, Leonard S, Deschodt M, Devriendt E, Wolthuis A, Prenen H, et al. The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: a systematic review. J Geriatr Oncol. 2016;7:479–91.

    PubMed  Google Scholar 

  5. Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC, Moss M. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013;206:544–50.

    PubMed  PubMed Central  Google Scholar 

  6. Ommundsen N, Wyller TB, Nesbakken A, Jordhøy MS, Bakka A, Skovlund E, et al. Frailty is an independent predictor of survival in older patients with colorectal Cancer. Oncologist. 2014;19:1268–75.

    PubMed  PubMed Central  Google Scholar 

  7. Mistry PK, Gaunay GS, Hoenig DM. Prediction of surgical complications in the elderly: can we improve outcomes? Asian J Urol. 2017;4:44–9.

    PubMed  Google Scholar 

  8. Poskus E, Kryzauskas M, Poskus T, Mikalauskas S, Samalavicius NE, Aliosin O, et al. Improved perioperative care is associated with improved long-term survival in colorectal cancer. Int J Color Dis. 2018;33:779–85.

    Google Scholar 

  9. Yang R, Wolfson M, Lewis MC. Unique aspects of the elderly surgical population. Geriatr Orthop Surg Rehabil. 2011;2:56–64.

    PubMed  PubMed Central  Google Scholar 

  10. Lu Q, Lu J-W, Wu Z, Liu X-M, Li J-H, Dong J, et al. Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery. Clin Interv Aging. 2018;13:133–41.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Aquina CT, Mohile SG, Tejani MA, Becerra AZ, Xu Z, Hensley BJ, et al. The impact of age on complications, survival, and cause of death following colon cancer surgery. Br J Cancer. 2017;116:389–97 Nature Publishing Group.

    PubMed  PubMed Central  Google Scholar 

  12. Kryzauskas M, Bausys A, Degutyte AE, Abeciunas V, Poskus E, Bausys R, et al. Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery. World J Surg Oncol. 2020;18:205.

    PubMed  PubMed Central  Google Scholar 

  13. Pérez Domínguez L, Cáceres Alvarado N, Toscano Novella Á, Casal Núñez JE. Results of colon cancer surgery in patients over 75 years old. ANZ J Surg. 2018;88:E11–5.

    PubMed  Google Scholar 

  14. Al-Abed Y, Parker M, Arulampalam T, Tutton M. Survival following rectal cancer surgery: does the age matter? Acta Chir Belg. 2019;119:282–8.

    PubMed  Google Scholar 

  15. Hallam S, Mothe B, Tirumulaju R. Hartmann’s procedure, reversal and rate of stoma-free survival. Ann R Coll Surg Engl. 2018;100:301–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. GlobalSurg Collaborative, Writing group, Glasbey JC, Adisa AO, Costas-Chavarri A, Qureshi AU, et al. Global variation in anastomosis and end colostomy formation following left-sided colorectal resection. BJS Open. 2019;3:403–14.

    Google Scholar 

  17. Kolarsick PA, Sacchi M, Spinelli A, Wexner SD. Minimizing the impact of colorectal surgery in the older patient: the role of minimally invasive surgery in the geriatric population. Eur J Surg Oncol. 2020;46:333–7 Elsevier.

    PubMed  Google Scholar 

  18. Keller DS, de Paula TR, Qiu J, Kiran RP. The Trends in Adoption, Outcomes, and Costs of Laparoscopic Surgery for Colorectal Cancer in the Elderly Population. J Gastrointest Surg. 2020; doi: https://doi.org/10.1007/s11605-020-04517-6 [cited 16 Nov 2020].

  19. Sehl M, Sawhney R, Naeim A. Physiologic aspects of aging: impact on cancer management and decision making, part II. Cancer J Sudbury Mass. 2005;11:461–73.

    Google Scholar 

  20. Vacante M, Cristaldi E, Basile F, Borzì AM, Biondi A. Surgical approach and geriatric evaluation for elderly patients with colorectal cancer. Updat Surg. 2019;71:411–7.

    Google Scholar 

  21. Levey AS, Eckardt K-U, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from kidney disease: improving global outcomes (KDIGO). Kidney Int. 2005;67:2089–100.

    PubMed  Google Scholar 

  22. Kim YW, Kim IY. Factors associated with postoperative complications and 1-year mortality after surgery for colorectal cancer in octogenarians and nonagenarians. Clin Interv Aging. 2016;11:689–97.

    PubMed  PubMed Central  Google Scholar 

  23. Hermans E, van Schaik PM, Prins HA, Ernst MF, Dautzenberg PJL, Bosscha K. Outcome of colonic surgery in elderly patients with Colon Cancer. J Oncol. 2010;2010:1–5.

    Google Scholar 

  24. Weerink LBM, Gant CM, van Leeuwen BL, de Bock GH, Kouwenhoven EA, Faneyte IF. Long-term survival in octogenarians after surgical treatment for colorectal Cancer: prevention of postoperative complications is key. Ann Surg Oncol. 2018;25:3874–82.

    PubMed  PubMed Central  Google Scholar 

  25. Tan K-K, Koh FH-X, Tan Y-Y, Liu JZ, Sim R. Long-term outcome following surgery for colorectal cancers in octogenarians: a single institution’s experience of 204 patients. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2012;16:1029–36.

    Google Scholar 

  26. Yen C, Simillis C, Choudhry M, Mills S, Warren O, Tekkis PP, et al. A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population. Acta Chir Belg. 2017;117:303–7.

    PubMed  Google Scholar 

  27. Zhou S, Zhou H, Zheng Z, Liang J, Zhou Z, Wang X. Predictive risk factors for anastomotic leakage after anterior resection of rectal cancer in elderly patients over 80 years old: an analysis of 288 consecutive patients. World J Surg Oncol. 2019;17:112.

    PubMed  PubMed Central  Google Scholar 

  28. Samuelsson KS, Egenvall M, Klarin I, Lökk J, Gunnarsson U. Preoperative geriatric assessment and follow-up of patients older than 75 years undergoing elective surgery for suspected colorectal cancer. J Geriatr Oncol. 2019;10:709–15.

    PubMed  Google Scholar 

  29. Mäkelä JT, Klintrup KH, Rautio TT. Mortality and survival after surgical treatment of colorectal Cancer in patients aged over 80 years. Gastrointest Tumors. 2017;4:36–44.

    PubMed  PubMed Central  Google Scholar 

  30. Zawadzki M, Krzystek-Korpacka M, Rząca M, Czarnecki R, Obuszko Z, Witkiewicz W. Colorectal surgery in elderly population. Pol Przegl Chir. 2018;90:29–34.

    PubMed  Google Scholar 

  31. Veyrie N, Ata T, Muscari F, Couchard A-C, Msika S, Hay J-M, et al. Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg. 2007;205:785–93.

    PubMed  Google Scholar 

  32. Tian Y, Xu B, Yu G, Li Y, Liu H. Comorbidity and the risk of anastomotic leak in Chinese patients with colorectal cancer undergoing colorectal surgery. Int J Color Dis. 2017;32:947–53.

    Google Scholar 

  33. Lago V, Fotopoulou C, Chiantera V, Minig L, Gil-Moreno A, Cascales-Campos PA, et al. Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: a multi-Centre study. Gynecol Oncol. 2019;153:549–54.

    CAS  PubMed  Google Scholar 

  34. Hoshino N, Fukui Y, Hida K, Sakai Y. Short-term outcomes of laparoscopic surgery for colorectal cancer in the elderly versus non-elderly: a systematic review and meta-analysis. Int J Color Dis. 2019;34:377–86.

    Google Scholar 

  35. Banysch M, Akkaya T, Gurenko P, Papadakis M, Heuer T, Kasim E, et al. Surgery for colorectal cancer in elderly patients: is there such a thing as being too old? Il G Chir. 2018;39:355–62.

    CAS  Google Scholar 

  36. Manceau G, Karoui M, Werner A, Mortensen NJ, Hannoun L. Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients: a systematic review. Lancet Oncol. 2012;13:e525–36.

    PubMed  Google Scholar 

  37. Law WL, Choi HK, Ho JW, Lee YM, Seto CL. Outcomes of surgery for mid and distal rectal cancer in the elderly. World J Surg. 2006;30:598–604.

    PubMed  Google Scholar 

  38. van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210–8.

    PubMed  Google Scholar 

  39. Jeong S-Y, Park JW, Nam BH, Kim S, Kang S-B, Lim S-B, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15:767–74.

    PubMed  Google Scholar 

  40. Stevenson ARL, Solomon MJ, Brown CSB, Lumley JW, Hewett P, Clouston AD, et al. Disease-free survival and local recurrence after laparoscopic-assisted resection or open resection for rectal Cancer: the Australasian laparoscopic Cancer of the rectum randomized clinical trial. Ann Surg. 2019;269:596–602.

    PubMed  Google Scholar 

  41. Veldkamp R, Kuhry E, Hop WCJ, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.

    PubMed  Google Scholar 

  42. Kitano S, Inomata M, Mizusawa J, Katayama H, Watanabe M, Yamamoto S, et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol. 2017;2:261–8.

    PubMed  Google Scholar 

  43. McCombie AM, Frizelle F, Bagshaw PF, Frampton CM, Hewett PJ, McMurrick PJ, et al. The ALCCaS trial: a randomized controlled trial comparing quality of life following laparoscopic versus open colectomy for Colon Cancer. Dis Colon Rectum. 2018;61:1156–62.

    PubMed  Google Scholar 

  44. Mamidanna R, Burns EM, Bottle A, Aylin P, Stonell C, Hanna GB, et al. Reduced risk of medical morbidity and mortality in patients selected for laparoscopic colorectal resection in England: a population-based study. Arch Surg Chic Ill 1960. 2012;147:219–27.

    Google Scholar 

  45. Gietelink L, Wouters MWJM, Bemelman WA, Dekker JW, Tollenaar RAEM, Tanis PJ, et al. Reduced 30-day mortality after laparoscopic colorectal Cancer surgery: a population based study from the Dutch surgical colorectal audit (DSCA). Ann Surg. 2016;264:135–40.

    PubMed  Google Scholar 

  46. Delgado S, Lacy AM, García Valdecasas JC, Balagué C, Pera M, Salvador L, et al. Could age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc. 2000;14:22–6.

    CAS  PubMed  Google Scholar 

  47. Sklow B, Read T, Birnbaum E, Fry R, Fleshman J. Age and type of procedure influence the choice of patients for laparoscopic colectomy. Surg Endosc. 2003;17:923–9.

    CAS  PubMed  Google Scholar 

  48. Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum. 2008;51:296–300.

    PubMed  Google Scholar 

  49. Tomimaru Y, Ide Y, Murata K. Outcome of laparoscopic surgery for colon cancer in elderly patients. Asian J Endosc Surg. 2011;4:1–6.

    CAS  PubMed  Google Scholar 

  50. She W-H, Poon JT-C, Fan JK-M, Lo OS-H, Law W-L. Outcome of laparoscopic colectomy for cancer in elderly patients. Surg Endosc. 2013;27:308–12.

    PubMed  Google Scholar 

  51. Niemeläinen S, Huhtala H, Ehrlich A, Kössi J, Jämsen E, Hyöty M. Long-term survival following elective colon cancer surgery in the aged. A population-based cohort study. Color Dis. 2020;22:1585–96.

    Google Scholar 

  52. Mothes H, Bauschke A, Schuele S, Eigendorff E, Altendorf-Hofmann A, Settmacher U. Surgery for colorectal cancer in elderly patients: how can we improve outcome? J Cancer Res Clin Oncol. 2017;143:1879–89.

    PubMed  Google Scholar 

  53. Kim JH. Chemotherapy for colorectal cancer in the elderly. World J Gastroenterol. 2015;21:5158.

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Tevis SE, Kohlnhofer BM, Stringfield S, Foley EF, Harms BA, Heise CP, et al. Postoperative Complications in Patients With Rectal Cancer Are Associated With Delays in Chemotherapy That Lead to Worse Disease-free and Overall Survival. Dis Colon Rectum. 2013;56:1339–48.

    PubMed  Google Scholar 

  55. Gao P, Huang X, Song Y, Sun J, Chen X, Sun Y, et al. Impact of timing of adjuvant chemotherapy on survival in stage III colon cancer: a population-based study. BMC Cancer. 2018;18:234.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgments

Not applicable.

Funding

Audrius Dulskas received funding for the study by the European Social Fund under the No 09.3.3-LMT-K-712 “Development of Competencies of Scientists, other Researchers, and Students through Practical Research Activities” measure. The funding played no role in the design of this study, the collection, analysis, and interpretation of data, or the preparation of the manuscript.

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Authors

Contributions

Study conception design: MK, AB, EP, RB, AD, KS, TP. Data acquisition: TP, KB, MK, AB. Data analysis and interpretation: MK, AB, TP. Drafting the article: MK, AB, KB, RB, JK, TP. Critical revision for intellectual content: EP, AD, KS, TP. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Marius Kryzauskas.

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Ethics approval and consent to participate

Vilnius Regional Research Ethics Committee approval (No. 2019/3–116-608) was obtained before the study. Because this study was retrospective and all included data were anonymous, the requirement that patients give informed consent was waived. Waiver of informed consent was approved by Vilnius Regional Research Ethics Committee.

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Not applicable.

Competing interests

The authors have no conflict of interest to declare.

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Kryzauskas, M., Bausys, A., Kuliavas, J. et al. Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer. BMC Geriatr 21, 682 (2021). https://doi.org/10.1186/s12877-021-02648-2

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Keywords

  • Colorectal cancer
  • Elderly
  • Morbidity
  • Mortality
  • Anastomotic leakage