Impact of Frailty On 5-Year Survival In Patients Older Than 70 Years Undergoing Colorectal Surgery for Cancer
| Autor: | María Asunción Acosta-Mérida, Manuel Artiles-Armas, Joaquín Marchena-Gómez, Cristina Roque-Castellano, Alicia Conde-Martel, Roberto Fariña-Castro |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Canada Multivariate analysis Colorectal cancer lcsh:Surgery Comorbidity lcsh:RC254-282 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Neoplasms medicine Humans 030212 general & internal medicine Elective surgery Geriatric Assessment Digestive System Surgical Procedures Aged Geriatrics Aged 80 and over Univariate analysis Frailty business.industry Research lcsh:RD1-811 lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease Prognosis Colorectal surgery Oncology 030220 oncology & carcinogenesis Child Preschool Cohort Surgery Female business Colorectal Surgery |
| Zdroj: | World Journal of Surgical Oncology World Journal of Surgical Oncology, Vol 19, Iss 1, Pp 1-13 (2021) |
| DOI: | 10.21203/rs.3.rs-178103/v1 |
| Popis: | Background Frailty has been shown to be a good predictor of post-operative complications and death in patients undergoing gastrointestinal surgery. The aim of this study was to analyze the differences between frail and non-frail patients undergoing colorectal cancer surgery, as well as the impact of frailty on long-term survival in these patients. Methods A cohort of 149 patients aged 70 years and older who underwent elective surgery for colorectal cancer was followed-up for at least 5 years. The sample was divided into two groups: frail and non-frail patients. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) was used to detect frailty. The two groups were compared with regard to demographic data, comorbidities, functional and cognitive statuses, surgical risk, surgical variables, tumor extent, and post-operative outcomes, which were mortality at 30 days, 90 days, and 1 year after the procedure. Univariate and multivariate analyses were also performed to determine which of the predictive variables were related to 5-year survival. Results Out of the 149 patients, 96 (64.4%) were men and 53 (35.6%) were women, with a median age of 75 years (IQR 72–80). According to the CSHA-CFS scale, 59 (39.6%) patients were frail, and 90 (60.4%) patients were not frail. Frail patients were significantly older and had more impaired cognitive status, worse functional status, more comorbidities, more operative mortality, and more serious complications than non-frail patients. Comorbidities, as measured by the Charlson Comorbidity Index (p = 0.001); the Lawton-Brody Index (p = 0.011); failure to perform an anastomosis (p = 0.024); nodal involvement (p = 0.005); distant metastases (p < 0.001); high TNM stage (p = 0.004); and anastomosis dehiscence (p = 0.013) were significant univariate predictors of a poor prognosis on univariate analysis. Multivariate analysis of long-term survival, with adjustment for age, frailty, comorbidities and TNM stage, showed that comorbidities (p = 0.002; HR 1.30; 95% CI 1.10–1.54) and TNM stage (p = 0.014; HR 2.06; 95% CI 1.16–3.67) were the only independent risk factors for survival at 5 years. Conclusions Frailty is associated with poor short-term post-operative outcomes, but it does not seem to affect long-term survival in older patients with colorectal cancer. Instead, comorbidities and tumor stage are good predictors of long-term survival. |
| Databáze: | OpenAIRE |
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