Advertisement

Frailty assessment can predict textbook outcomes in senior adults after minimally invasive colorectal cancer surgery

Published:November 08, 2022DOI:https://doi.org/10.1016/j.ejso.2022.11.006

      Abstract

      Aim

      Colorectal cancer (CRC) surgery can be associated with suboptimal outcomes in older patients. The aim was to identify the correlation between frailty and surgical variables with the achievement of Textbook Outcome (TO), a composite measure of the ideal postoperative course, by older patients with CRC.

      Method

      All consecutive patients ≥70years who underwent elective CRC-surgery between January 2017 and November 2021 were analyzed from a prospective database. To obtain a TO, all the following must be achieved: 90-day survival, Clavien-Dindo (CD) < 3, no reintervention, no readmission, no discharge to rehabilitation facility, no changes in the living situation and length of stay (LOS) ≤5days/≤14days for colon and rectal surgery respectively. Frailty and surgical variables were related to the achievement of TO.

      Results

      Four-hundred-twenty-one consecutive patients had surgery (97.7% minimally invasive), 24.9% for rectal cancer, median age 80 years (range 70–92), median LOS of 4 days (range 1–96). Overall, 288/421 patients (68.4%) achieved a TO. CD 3–4 complications rate was 6.4%, 90-day mortality rate was 2.9%.
      At univariate analysis, frailty and surgical variables (ileostomy creation, p = 0.045) were related to. However, multivariate analysis showed that only frailty measures such as flemish Triage Risk Screening Tool≥2 (OR 1.97, 95%CI: 1.23–3.16; p = 0.005); Charlson Index>6 (OR 1.61, 95%CI: 1.03–2.51; p = 0.036) or Timed-Up-and-Go>20 s (OR 2.06, 95%CI: 1.01–4.19; p = 0.048) independently predicted an increased risk of not achieving a TO.

      Conclusion

      The association between frailty and comprehensive surgical outcomes offers objective data for guiding family counseling, managing expectations and discussing the possible loss of independence with patients and caregivers.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Siegel R.L.
        • Miller K.D.
        • Jemal A.
        Cancer statistics, 2020.
        CA A Cancer J Clin. 2020 Jan; 70: 7-30
        • Ghignone F.
        • van Leeuwen B.L.
        • Montroni I.
        • Huisman M.G.
        • Somasundar P.
        • Cheung K.L.
        • et al.
        The assessment and management of older cancer patients: a SIOG surgical task force survey on surgeons’ attitudes.
        Eur J Surg Oncol. 2016 Feb; 42: 297-302
        • Shahrokni A.
        • Alexander K.
        The age of talking about age alone is over.
        Ann Surg Oncol. 2019 Jan; 26: 12-14
        • Oakland K.
        • Nadler R.
        • Cresswell L.
        • Jackson D.
        • Coughlin P.A.
        Systematic review and meta-analysis of the association between frailty and outcome in surgical patients.
        Ann R Coll Surg Engl. 2016 Feb; 98: 80-85
        • Warps A.K.
        • Detering R.
        • Tollenaar R.A.E.M.
        • Tanis P.J.
        • Dekker J.W.T.
        Dutch ColoRectal Audit group. Textbook outcome after rectal cancer surgery as a composite measure for quality of care: a population-based study.
        Eur J Surg Oncol. 2021 Nov; 47: 2821-2829
        • Katz S.
        • Ford A.B.
        • Moskowitz R.W.
        • Jackson B.A.
        • Jaffe M.W.
        Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function.
        J Am Med Assoc. 1963 Sep 21; 185: 914e9
        • Chang C.M.
        • Yin W.Y.
        • Wei C.K.
        • Wu C.C.
        • Su Y.C.
        • Yu C.H.
        • et al.
        Age-adjusted Charlson comorbidity index score as a risk measure of perioperative mortality before cancer surgery.
        PLoS One. 2016 Feb 5; : 11e0148076
        • Ethun C.G.
        • Bilen M.A.
        • Jani A.B.
        • Maithel S.K.
        • Ogan K.
        • Master V.A.
        Frailty and cancer:implications for oncology surgery, medical oncology, and radiation oncology.
        CA Cancer J Clin, 2017
        • Kondrup J.
        • Rasmussen H.H.
        • Hamberg O.
        • Stanga Z.
        Ad hoc ESPEN working group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.
        Clin Nutr. 2003; 22: 321-336
        • Deschodt M.
        • Wellens N.I.H.
        • Braes T.
        • De Vuyst A.
        • Boonen S.
        • Flamaing J.
        • et al.
        Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools.
        Aging Clin Exp Res. Oct-Dec 2011; 23: 421-426
        • Brouquet A.
        • Cudennec T.
        • Benoist S.
        • Moulias S.
        • Beauchet A.
        • Penna C.
        • et al.
        Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery.
        Ann Surg. 2010 Apr; 251: 759-765
        • Saur N.M.
        • Montroni I.
        • Shahrokni A.
        • Kunitake H.
        • Potenti F.M.
        • Goodacre R.C.
        • et al.
        Care of the geriatric colorectal surgical patient and framework for creating a geriatric program: a compendium from the 2019 American society of colon and rectal surgeons annual meeting.
        Dis Colon Rectum. 2020 Nov; 63: 1489-1495
        • Audisio R.A.
        • Pope D.
        • Ramesh H.S.
        • Gennari M.
        • van Leeuwen B.L.
        • West C.
        • et al.
        Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study.
        Crit Rev Oncol Hematol. 2008; 65: 156-163
        • Chang C.M.
        • Yin W.Y.
        • Wei C.K.
        • Wu C.C.
        • Su Y.C.
        • Yu C.H.
        • et al.
        Age-adjusted Charlson comorbidity index score as a risk measure of perioperative mortality before cancer surgery.
        PLoS One. 2016 Feb 5; : 11e0148076
        • Fagard K.
        • Casaer J.
        • Wolthuis A.
        • Flamaing J.
        • Milisen K.
        • Lobelle J.P.
        • et al.
        Value of geriatric screening and assessment in predicting postoperative complications in patients older than 70 years undergoing surgery for colorectal cancer.
        J Geriatr Oncol. 2017 Sep; 8: 320-327
        • Huisman M.G.
        • Van Leeuwen B.L.
        • Ugolini G.
        • Montroni I.
        • Spiliotis J.
        • Stabilini C.
        • et al.
        “Timed Up & Go”: a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study.
        PLoS One. 2014 Jan 26; 11e0147993
        • Zattoni D.
        • Montroni I.
        • Saur N.M.
        • Garutti A.
        • Bacchi Reggiani M.L.
        • Galetti C.
        • et al.
        A simple screening tool to predict outcomes in older adults undergoing emergency general surgery.
        J Am Geriatr Soc. 2019 Feb; 67: 309-316
        • Huisman M.G.
        • Veronese G.
        • Audisio R.A.
        • Ugolini G.
        • Montroni I.
        • de Bock G.H.
        • et al.
        Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients – a multicentre cohort study.
        Eur J Surg Oncol. 2016; Jul; 42: 1009-1017
        • Hwee Tan J.K.
        • Ang J.J.
        • Hong Chan D.K.
        Enhanced recovery program versus conventional care after colorectal surgery in the geriatric population: a systematic review and meta-analysis.
        Surg Endosc. 2020 May 28; 35: 3166-3174
        • Ostermann S.
        • Morel P.
        • Chalé J.J.
        • Bucher P.
        • Konrad B.
        • Meier R.P.H.
        • et al.
        Randomized controlled trial of enhanced recovery program dedicated to elderly patients after colorectal surgery.
        Dis Colon Rectum. 2019 Sep; 62: 1105-1116
        • Sharp S.P.
        • Malizia R.
        • Skancke M.
        • Arsoniadis E.G.
        • Ata A.
        • Stain S.C.
        • et al.
        A NSQIP analysis of trends in surgical outcomes for rectal cancer: what can we improve upon?.
        Am J Surg. 2020; 220: 401-407https://doi.org/10.1016/j.amjsurg.2020.01.004
        • Dindo MD, D.
        • Demartines MD, N.
        • Clavien P.D.
        A new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004 Aug; 240: 205-213
        • Montroni I.
        • Ugolini G.
        • Saur N.M.
        • Spinelli A.
        • Rostoft S.
        • Millan M.
        • et al.
        Personalized management of elderly patients with rectal cancer: expert recommendations of the European society of surgical Oncology, European society of coloproctology, international society of geriatric Oncology, and American college of surgeons commission on cancer.
        Eur J Surg Oncol. 2018 Nov; 44: 1685-1702
        • Chesney T.R.
        • Haas B.
        • Coburn N.G.
        • Mahar A.L.
        • Zuk V.
        • Zhao H.
        • et al.
        Recovery after surgical therapy for older adults research–cancer (RESTORE-Cancer) group. Patient-centered time-at-home outcomes in older adults after surgical cancer treatment.
        JAMA Surg. 2020; 7e203754
        • 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 Nov; 7: 479-491
        • Gearhart S.L.
        • Do E.M.
        • Owodunni O.
        • Gabre-Kidan A.A.
        • Magnuson T.
        Loss of independence in older patients after operation for colorectal cancer.
        J Am Coll Surg. 2020 Apr; 230: 573-582
        • Kenis C.
        • Geeraerts A.
        • Braesl T.
        • Milisen K.
        • Flamaing J.
        • Wildiers H.
        The Flemish version of the Triage Risk Screening Tool (TRST): a multidimensional short screening tool for the assessment of elderly patients.
        Crit Rev Oncol Hematol. 2006; 60: S31
        • Tyler J.A.
        • Fox J.P.
        • Dharmarajan S.
        • Silviera M.L.
        • Hunt S.R.
        • Wise P.E.
        • et al.
        Acute health care resource utilization for ileostomy patients is higher than expected.
        Dis Colon Rectum. 2014; 57: 1412-1420
        • Fish D.R.
        • Mancuso C.A.
        • Garcia-Aguilar J.E.
        • Lee S.W.
        • Nash G.M.
        • Sonoda T.
        • et al.
        Readmission after ileostomy creation: retrospective review of a common and significant event.
        Ann Surg. 2017 Feb; 265: 379-387
        • Messaris E.
        • Sehgal R.
        • Deiling S.
        • Koltun W.A.
        • Stewart D.
        • McKenna K.
        • et al.
        Dehydration is the most common indication for readmission after diverting ileostomy creation.
        Dis Colon Rectum. 2012; 55: 175-180
        • Jonker F.H.
        • Tanis P.J.
        • Coene P.P.
        • Gietelink L.
        • van der Harst E.
        Dutch Surgical Colorectal Audit Group. Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry.
        Colorectal Dis. 2016; 18: 785-792
        • Hamaker M.E.
        • Wildes T.M.
        • Rostoft S.
        Time to stop saying geriatric assessment is too time consuming.
        J Clin Oncol. 2017 Sep 1; 35: 2871-2874