Comprehensive multidisciplinary care program for elderly colorectal cancer patients: "From prehabilitation to independence".

Autor: Souwer ETD; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands. Electronic address: e.souwer@hagaziekenhuis.nl., Bastiaannet E; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands., de Bruijn S; Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands., Breugom AJ; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., van den Bos F; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands., Portielje JEA; Department of Internal Medicine, Haga Hospital, The Hague, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands., Dekker JWT; Department of Surgery, Reinier de Graaf Hospital, Delft, the Netherlands.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2018 Dec; Vol. 44 (12), pp. 1894-1900. Date of Electronic Publication: 2018 Sep 08.
DOI: 10.1016/j.ejso.2018.08.028
Abstrakt: Background: We implemented a multidisciplinary pre- and rehabilitation program for elderly patients (≥75 years of age) in a single center consisting of prehabilitation, laparoscopic surgery and early rehabilitation with the intention to lower 1-year overall mortality.
Methods: In this study we compared all patients that underwent elective surgery for stage I-III colorectal cancer before and during development and after implementation of the program (2010-2011, 2012-2013 and 2014-2015). Primary endpoint was 1-year overall mortality, the secondary endpoint was 30-day postoperative outcome.
Results: Eighty-six consecutive patients were included in the study cohort and compared to 63 patients from 2010 to 2011 and 75 patients from 2012 to 2013. Patient characteristics were comparable; median age in the study cohort was 80.6. Seventy-three patients (85%) participated in the program, 54 (63%) of whom followed a prehabilitation program, 46 (53%) of whom were discharged to a rehabilitation center. Laparoscopic surgery increased over the years from 70% to 83% in the study cohort. There was a trend in lower 1-year overall mortality: 11% versus 3% (p=0.08). There was a significant reduction in cardiac complications and the number of patients with a prolonged length of stay (p < 0.01).
Conclusions: Multidisciplinary care for elderly colorectal cancer patients that includes prehabilitation and rehabilitation is feasible and may contribute to lower complications and reduced length of stay. This study did not show a clear benefit of implementing a comprehensive care program including both prehabilitation and rehabilitation. Dedicated multidisciplinary care seems the key attributer to favorable outcomes of CRC surgery in elderly patients.
(Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)
Databáze: MEDLINE
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