Radical surgery outcomes in colorectal cancer patients aged younger and older than 75 years

Objective: to evaluate surgical treatment outcomes in colorectal cancer patients aged younger and older than 75 years.
Materials and methods. A retrospective analysis of medical records was conducted for 582 colorectal cancer patients treated between January 1, 2019, and December 1, 2024, at the Department of Abdominal Oncology Surgery, Regional Clinical Oncology Hospital, Ulyanovsk, Russia. Based on inclusion and exclusion criteria, 572 patients were included in the study. Postoperative complications were assessed using the Clavien–Dindo classifcation, and tumors were staged according to the TNM system. The patients were categorized into two age groups: a younger group consisting of patients younger than 75 years, and an older group including those aged 75 years or older.
Results. Univariate analysis revealed no statistically signifcant differences in baseline clinical and demographic characteristics or comorbidities between the patient groups. However, the Charlson comorbidity index was signifcantly higher in patients aged 75 years and older (p < 0.001). Compared to the younger group patients, the older group patients more frequently underwent right-sided hemicolectomy (58, 56.9%), followed by sigmoid colon resection (38, 37.3%). The incidence of anastomotic leakage was higher in older patients than in younger patients, but this difference did not reach statistical signifcance (p = 0.065). No signifcant differences in postoperative complications stratifed by the Clavien–Dindo classifcation were found between the patient groups (p = 0.247). Multilevel logistic regression identifed the following predictors of anastomotic leakage: preoperative albumin level, albumin level on postoperative days 1 and 5, as well as the neutrophil-to-lymphocyte ratio on postoperative days 1 and 5.
Conclusion. Patient age is not considered an independent factor for anastomotic leakage after colorectal cancer resection. Signifcant predictors of anastomotic leakage include NLR on postoperative days 1 and 5, as well as preoperative albumin levels and albumin levels on postoperative days 1 and 5.

1. Bray F., Laversanne M., Sung H., Ferlay J., Siegel R.L., Soerjomataram I., Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024; 74(3): 229–63. doi: 10.3322/caac.21834.

2. Normann M., Ekerstad N., Angenete E., Prytz M. Mortality and morbidity after colorectal cancer resection surgery in elderly patients: a retrospective population-based study in Sweden. World J Surg Oncol. 2024; 22(1): 23. doi: 10.1186/s12957-024-03316-6.

3. Neuman H.B., O’Connor E.S., Weiss J., Loconte N.K., Greenblatt D.Y., Greenberg C.C., Smith M.A. Surgical treatment of colon cancer in patients aged 80 years and older : analysis of 31,574 patients in the SEER-Medicare database. Cancer. 2013; 119(3): 639–47. doi: 10.1002/cncr.27765.

4. Gülcü B., Yılmazlar T., Işık Ö., Öztürk E. Colorectal cancer surgery in octogenarians. Turk J Surg. 2018; 34(4): 271–75. doi: 10.5152/turkjsurg.2018.4018.

5. Davey M.G., Joyce W.P. Impact of frailty on oncological outcomes in patients undergoing surgery for colorectal cancer – A systematic review and meta-analysis. Surgeon. 2023; 21(3): 173–80. doi: 10.1016/j.surge.2022.06.001.

6. Goldstraw P., Crowley J., Chansky K., Giroux D.J., Groome P.A., Rami-Porta R., Postmus P.E., Rusch V., Sobin L.; International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007; 2(8): 706–14. doi: 10.1097/JTO.0b013e31812f3c1a. Erratum in: J Thorac Oncol. 2007; 2(10): 985.

7. Lee S.M., Shin J.S. Colorectal Cancer in Octogenarian and Nonagenarian Patients: Clinicopathological Features and Survivals. Ann Coloproctol. 2020; 36(5): 323–29. doi: 10.3393/ac.2020.01.19.2.

8. Shelygin Yu.A., Nagudov M.A., Ponomarenko A.A., Alekseev M.V., Rybakov E.G., Tarasov M.A., Achkasov S.I. Meta-analysis of management of colorectal anastomotic leakage. Pirogov Russian Journal of Surgery. 2018; 8-2: 30–41. (in Russian). doi: 10.17116/hirurgia201808230. EDN YAUQJN.

9. Church S., Rogers E., Rockwood K., Theou O. A scoping review of the Clinical Frailty Scale. BMC Geriatr. 2020; 20(1): 393. doi: 10.1186/s12877-020-01801-7.

10. Hermans E., van Schaik P.M., Prins H.A., Ernst M.F., Dautzenberg P.J., Bosscha K. Outcome of colonic surgery in elderly patients with colon cancer. J Oncol. 2010; 2010: 865908. doi: 10.1155/2010/865908.

11. Kulikov V.D., Danilova L.A., Prokhorov D.D., Midlenko O.V., Zhinov A.V., Toneev E.A., Shagdaleev R.F., Mukhutdinova A.N., Martynova E.V., Murtazin A.R., Pavlov M.O., Nuretdinov D.I., Choshchiev A. Database of hemicolectomies performed in the regional oncology hospital over a threeyear period: No. 2024622107: declared. 16.05.2024: published. 29.05.2024. Certificate of state registration of the database No. 2024622330 Russian Federation. (in Russian). EDN: LECDWF.

12. Fedyanin M.Yu., Gladkov O.A., Gordeev S.S., Karachun A.M., Kozlov N.A., Mammadli Z.Z., Rykov I.V., Tryakin A.A., Tsukanov A.S., Chernykh M.V. Practical recommendations for the drug treatment of colon cancer, rectosigmoid compound and direct. Malignant Tumors 2022; 12(3S2-1): 401–54. (in Russian). doi: 10.18027/2224-5057-2022-12-3s2-401-454. EDN: BMPEEE.

13. Charlson M.E., Carrozzino D., Guidi J., Patierno C. Charlson Comorbidity Index: A Critical Review of Clinimetric Properties. Psychother Psychosom. 2022; 91(1): 8–35. doi: 10.1159/000521288.

14. Clavien P.A., Barkun J., de Oliveira M.L., Vauthey J.N., Dindo D., Schulick R.D., de Santibañes E., Pekolj J., Slankamenac K., Bassi C., Graf R., Vonlanthen R., Padbury R., Cameron J.L., Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250(2): 187–96. doi: 10.1097/SLA.0b013e3181b13ca2.

15. Rahbari N.N., Weitz J., Hohenberger W., Heald R.J., Moran B., Ulrich A. Holm T., Wong W.D., Tiret E., Moriya Y., Laurberg S., den Dulk M., van de Velde C., Büchler M.W. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010; 147(3): 339–51. doi: 10.1016/j.surg.2009.10.012.

16. Violi V., Pietra N., Grattarola M., Sarli L., Choua O., Roncoroni L., Peracchia A. Curative surgery for colorectal cancer: long-term results and life expectancy in the elderly. Dis Colon Rectum. 1998; 41(3): 291–98. doi: 10.1007/BF02237482.

17. Lyadov V.K., Kochatkov A.V., Negardinov A.Z., Bogdanov A.A. Results of radical laparoscopic surgery for colorectal cancer in elderly and senile patients. P.A. Herzen Journal of Oncology. 2017; 6(3): 17–20. (in Russian). doi: 10.17116/onkolog20176317-20. EDN: YTDRMJ.

18. Shchaeva S.N., Efron A.G., Magidov L.A., Volynets L.I. Overall survival in elderly patients with acute complications of colorectal cancer. Koloproctology. 2021; 20(3): 62–70. (in Russian). doi: 10.33878/2073-7556-2021-20-3-62-70. EDN: CUDZXT.

19. Hinoi T., Kawaguchi Y., Hattori M., Okajima M., Ohdan H., Yamamoto S., Hasegawa H., Horie H., Murata K., Yamaguchi S., Sugihara K., Watanabe M; Japan Society of Laparoscopic Colorectal Surgery. Laparoscopic versus open surgery for colorectal cancer in elderly patients: a multicenter matched case-control study. Ann Surg Oncol. 2015; 22(6): 2040–50. doi: 10.1245/s10434-014-4172-x.

20. Okabe H., Ohsaki T., Ogawa K., Ozaki N., Hayashi H., Akahoshi S., Ikuta Y., Ogata K., Baba H., Takamori H. Frailty predicts severe postoperative complications after elective colorectal surgery. Am J Surg. 2019; 217(4): 677–81. doi: 10.1016/j.amjsurg.2018.07.009.

21. Fagard K., Leonard S., Deschodt M., Devriendt E., Wolthuis A., Prenen H., Flamaing J., Milisen K., Wildiers H., Kenis C. 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; 7(6): 479–91. doi: 10.1016/j.jgo.2016.06.001.

22. Lyadov V.K., Garipov M.R., Polushkin V.G., Tarasov N.A., Ayupov R.T., Feoktistov D.V. C-reactive protein as early predictor of anastomotic leakage after surgery for colorectal cancer. Systematic review and meta-analysis. Pirogov Russian Journal of Surgery. 2020; 8: 82–87. (in Russian). doi: 10.17116/hirurgia202008182. EDN: HQLPQJ.

23. Balkarov A.A., Alekseev M.V., Rybakov E.G., Frolov S.A., Achkasov S.I. Prevention of colorectal anastomotic leakage using its reinforcement (results of the randomized study). Pirogov Russian Journal of Surgery. 2021; 7: 18–23. (in Russian). doi: 10.17116/hirurgia202107118. EDN: YTNGCI.

24. 2015 European Society of Coloproctology Collaborating Group. Predictors for Anastomotic Leak, Postoperative Complications, and Mortality After Right Colectomy for Cancer: Results From an International Snapshot Audit. Dis Colon Rectum. 2020; 63(5): 606–18. doi: 10.1097/DCR.0000000000001590.

25. Lemmens V.E., Janssen-Heijnen M.L., Verheij C.D., Houterman S., Repelaer van Driel O.J., Coebergh J.W. Co-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer. Br J Surg. 2005; 92(5): 615–23. doi: 10.1002/bjs.4913.

26. Emile S.H., Khan S.M., Wexner S.D. A systematic review and meta-analysis of the outcome of ileal pouch anal anastomosis in patients with obesity. Surgery. 2021; 170(6): 1629–36. doi: 10.1016/j.surg.2021.06.009.

27. González-Senac N.M., Mayordomo-Cava J., Macías-Valle A., Aldama-Marín P., Majuelos González S., Cruz Arnés M.L., JiménezGómez L.M., Vidán-Astiz M.T., Serra-Rexach J.A. Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison. Int J Environ Res Public Health. 2021; 18(11): 6072. doi: 10.3390/ijerph18116072.

28. Ivanov Yu.V., Smirnov A.V., Davidovich D.L., Keshvedinova A.A., Razbirin D.V., Stankevich V.R., Danilina E.S. Predictors of anastomotic leak after anterior rectal resections for localized malignant neoplasms. Journal of Clinical Practice. 2024; 15(1): 7–16. (in Russian). doi: 10.17816/clinpract623690. EDN: TZYWHN.

29. Shen N.P., Kosterin M.D., Latnikova V.A., Abukerimova S.K., Galeev M.S., Korobeinikova E.D. Hypoalbuminemia as an independent predictor of complications, critical illness and premature death. Russian Journal of Anesthesiology and Reanimatology. 2024; 4: 83–89. (in Russian). doi: 10.17116/anaesthesiology202404183. EDN: RPTUHM.

30. Lyadov V.K., Boldyreva T.S., Prokhorov E.V., Galkin V.N. Multimodal prehabilitation in a patient with right colon cancer, frailty and severe sarcopenia: a case report. Pelvic Surgery and Oncology. 2023; 13(2): 60–65. (in Russian). doi: 10.17650/2686-9594-2023-13-2-60-65. EDN: DNUABV.

31. Cherkasov M.F., Dmitriev A.V., Pereskokov S.V., Kozyrevskiy M.A., Afunts L.S. Risk factors and their impact on the viability of a colorectal anastomosis. Modern Problems of Science and Education. 2018; (4): 141. (in Russian). EDN: MGDMWT.