Outcomes of Emergency and Elective Surgical Interventions for Left Colon Cancer in Elderly and Senile Patients

RELEVANCE. An analysis of postoperative morbidity and mortality in elderly and senile patients who have undergone surgery on the left half of the colon helps identify predictive factors that influence the development of serious complications. THE

Aim

OF THE STUDY. To analyze predictive factors that have a negative effect on 90-day outcomes of surgeries in elderly and senile patients operated on for left colon cancer. MATERIAL AND

Methods

Inclusion criteria: age 70–89 years; patients with stage II–III left colon cancer who underwent emergency surgery for acute colonic obstruction and patients with uncomplicated colon cancer who underwent elective surgery; histological type of tumor — adenocarcinoma. A retrospective cohort study with pseudorandomization was conducted, including 2 groups: 1 — 257 patients who underwent emergency surgeries in clinical hospitals of Smolensk in the period from 10.10.2014 to 03.04.2023. Using the 1:1 pseudorandomization system by the nearest neighbor method, the 2nd group n=257 was formed — patients who underwent elective surgery in the same time period.

Results

The following patient-associated factors were studied: age, gender, Charlson Comorbidity Index, ASA status, preoperative white blood cell count, Creactive protein, hemoglobin; tumor-associated factors: tumor complications and its location, grade, local status, state of regional lymph nodes, as well as factors related to surgery: emergency/elective surgery, type of operations — decompressing colostomy at the first stage or resection of the colon, intraoperative blood loss, duration of surgery. We identified five main independent predictors that influence 90-day postoperative morbidity and mortality: CCI comorbidity index ≥ 7; acute colonic obstruction; general condition according to ASA ≥ 3; emergency resection of the left colon; intraoperative blood loss > 450 ml.

Conclusion

Stratification of elderly and senile patients suffering from left colon cancer is necessary. If the patient’s overall condition is ≥ III on the ASA scale, the Charlson Comorbidity Index (CCI) ≥ 7, acute bowel obstruction is present, and the blood C-reactive protein level is ≥ 10 mg/L, it seems appropriate to perform a minimally invasive procedure as the first emergency step, such as a decompression colostomy, as this approach is associated with a lower risk of postoperative morbidity and mortality within 90 days.