Urgente darmresecties bij ouderen met coloncarcinoom

Resultaten van de Dutch surgical colorectal audit

Journal article (2013)

Authors

N. E. Kolfschoten Leiden University Medical Center
M. W.J.M. Wouters Leiden University Medical Center, Nederlands Kanker Instituut - Antoni van Leeuwenhoek ziekenhuis
G. A. Gooiker Leiden University Medical Center
Nicoline J. Van Leersum Leiden University Medical Center
E. H. Eddes Deventer Hospitals, Leiden University Medical Center
Job Kievit Leiden University Medical Center
R.A.E.M. Tollenaar Leiden University Medical Center
P.J. Marang-van de Mheen Leiden University Medical Center
Affiliation
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Published Date

2013

Language

Dutch

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Abstract

Objective: The aim of the study was to identify risk factors for postoperative mortality in patients undergoing surgery for colon cancer. We looked specifically at patients ≥ 80 years of age in whom a nonelective colon cancer resection was performed. Study Design: Observational study. Methods: We included data from 6,161 patients who underwent colon cancer surgery in 2010 in a Dutch hospital; a nonelective colon cancer resection was performed in 1,172 of these patients. Risk factors for postoperative mortality were identified using a multivariate logistic regression analysis. We studied elective and nonelective intestinal resections separately in different age groups. Results: Mortality in the total study population was 4.9%. Mortality increased with age in patients who underwent either elective or nonelective intestinal resection. For patients ≥ 80 years of age who underwent nonelective intestinal resection, each additional risk factor doubled the mortality risk. In patients aged ≥ 80 years with an American Society of Anesthesiologists classification of class ≥ 3 who underwent a left hemicolectomy or 'other' intestinal resection, the postoperative mortality rate was 41%; in patients of the same age without additional risk factors this was 7%. CONCLUSIONS In patients ≥ 80 years of age with 2 or more additional risk factors, nonelective intestinal resection should be considered a high-risk procedure with a mortality risk of up to 41%. This result can be used in clinical decision making concerning treatment and in providing information for patients and their families.