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Can elderly patients with colorectal cancer tolerate planned surgical treatment? A practical approach to a common dilemma
Author(s) -
Ugolini G.,
Rosati G.,
Montroni I.,
Zanotti S.,
Manaresi A.,
Giampaolo L.,
Friederike Blume J.,
Taffurelli M.
Publication year - 2009
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2008.01676.x
Subject(s) - medicine , colorectal cancer , mortality rate , colon resection , population , anastomosis , surgery , stoma (medicine) , colectomy , cancer , general surgery , environmental health
Aim Analysing the effectiveness of a surgical procedure is mandatory in every modern health‐care system. The aging of the population stresses the need for a good standard of care. This study tests the hypothesis that porthsmouth‐physiologic operative severity score for enumeration of morbidity and mortality (P‐POSSUM) and colorectal‐POSSUM (CR‐POSSUM) would be useful clinical auditing tools in colorectal cancer surgery for aged patients. Method One hundred and seventy‐seven consecutive patients over 70 years of age underwent emergency or elective surgery from January 2003 to December 2005. Demographic, clinical and surgical information, score systems’ prediction, complications and 30‐day mortality data were prospectively entered in a comprehensive database. The observed over expected morbidity and mortality rate was calculated. Results Thirty‐day observed mortality was 10.3% (19/177) while P‐POSSUM and CR‐POSSUM expected mortality were, respectively, 11.21% ( P = NS) and 13.08% ( P = NS). Overall observed morbidity was 42.7%, P‐POSSUM prediction was 59.3% ( P = 0.002). Morbidity and mortality data were analysed for specific subgroups of patients (resection and anastomosis/resection and stoma/palliative; emergency/elective). Conclusion P‐POSSUM and CR‐POSSUM are useful tools to predict mortality in elderly patients. P‐POSSUM significantly overestimated the risk of complications. A more accurate tool for preoperative assessment for aged patients is probably needed to predict the post‐surgical outcome.