Efficacy of fast track surgery in elderly patients with colorectal cancer undergoing laparoscopic treatment: A meta-analysis

Background/Aims: Postoperative delirium (POD) is more frequent in elderly patients undergoing major cancer surgery. The interplay between individual clinical vulnerability and a series of perioperative factors seems to play a relevant role. Surgery is the first-line treatment option for cancer, and fast-track surgery (FTS) has been documented to decrease postoperative complications. The study sought to assess, after comprehensive geriatric assessment (CGA) and frailty stratification (Rockwood 40 items index), which perioperative parameters were predictive of POD development in elderly patients undergoing FTS for colorectal cancer. Methods: A total of 107 consecutive subjects admitted for elective colorectal FTS were enrolled. All patients underwent CGA, frailly stratification, Timed up & go (TUG) test, 4AT test for delirium screening, anesthesiologists physical status classification, and Dindo-Clavien classification. Results: The incidence of POD was 12.3%. Patients’ prevalent clinical phenotype was pre-frail. The multivariate analysis indicated physical performance (TUG in seconds) as the most significant predictor of POD for each second of increase. Conclusions: Only few procedure-specific studies have examined the impact of FTS for colorectal cancer on POD. This is the first study to investigate the risk factors for POD, in a vulnerable octogenarian oncogeriatric population submitted to FTS surgery and frailty stratification.

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THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

Koloproktologia ◽

10.33878/2073-7556-2016-0-1-26-29 ◽

2016 ◽

pp. 26-29

Author(s):

D. . Zitta ◽

V. . Subbotin ◽

Y. . Busirev

Keyword(s):

Colorectal Cancer ◽

Colorectal Surgery ◽

Blood Loss ◽

Elderly Patients ◽

Fast Track ◽

Randomized Study ◽

Conventional Group ◽

Intraoperative Blood Loss ◽

Elective Colorectal Surgery ◽

Complications Rate

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

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A clinical risk analysis of early post-operative delirium after laparoscopic colorectal cancer surgery in elderly patients: a retrospective study

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03919-5 ◽

2021 ◽

Author(s):

Masatsugu Hiraki ◽

Toshiya Tanaka ◽

Hironobu Ishii ◽

Eiji Sadashima ◽

Daisuke Miura ◽

...

Keyword(s):

Colorectal Cancer ◽

Retrospective Study ◽

Risk Analysis ◽

Elderly Patients ◽

Cancer Surgery ◽

Colorectal Cancer Surgery ◽

Clinical Risk ◽

Surgery In Elderly

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Clinical and oncologic outcomes of laparoscopic versus open surgery in elderly patients with colorectal cancer: a retrospective multicenter study

International Journal of Clinical Oncology ◽

10.1007/s10147-021-02009-4 ◽

2021 ◽

Author(s):

Il Tae Son ◽

Jeong Yeon Kim ◽

Min Jeong Kim ◽

Byung Chun Kim ◽

Byung Mo Kang ◽

...

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Multicenter Study ◽

Open Surgery ◽

Oncologic Outcomes ◽

Retrospective Multicenter Study ◽

Surgery In Elderly

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Systematic review with meta-analysis of over 90 000 patients. Does fast-track review diagnose colorectal cancer earlier?

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.15378 ◽

2019 ◽

Vol 50 (4) ◽

pp. 348-372 ◽

Cited By ~ 5

Author(s):

Ella Mozdiak ◽

Yonas Weldeselassie ◽

Michael McFarlane ◽

Maria Tabuso ◽

Monika M. Widlak ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Fast Track ◽

Meta Analysis

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The role of surgery in elderly patients with colorectal cancer

Critical Reviews in Oncology/Hematology ◽

10.1016/s1040-8428(08)70020-9 ◽

2008 ◽

Vol 68 ◽

pp. S14

Author(s):

R. Audisio

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Surgery In Elderly

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A meta-analysis of fast track surgery for patients with gastric cancer undergoing gastrectomy

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2015.97.1.3 ◽

2015 ◽

Vol 97 (1) ◽

pp. 3-10 ◽

Cited By ~ 21

Author(s):

S Chen ◽

Z Zou ◽

F Chen ◽

Z Huang ◽

G Li

Keyword(s):

Gastric Cancer ◽

Perioperative Care ◽

Fast Track ◽

Meta Analysis ◽

Cochrane Library ◽

Fast Track Surgery ◽

Short Term ◽

Readmission Rates ◽

Randomised Controlled

Introduction This meta-analysis evaluated the safety and efficacy of fast track surgery (FTS) for patients with gastric cancer undergoing gastrectomy. Methods Randomised controlled trials (RCTs) published between 1 January 1995 and 21 June 2013 comparing FTS with conventional perioperative care for patients with gastric cancer undergoing gastrectomy were identified in the PubMed, Embase™ and Cochrane Library databases, and were analysed systematically using RevMan software (Nordic Cochrane Centre, Copenhagen, Denmark). Results Seven RCTs (524 patients) were analysed. Compared with conventional perioperative care, FTS treatment with/without laparoscopy was associated with shorter postoperative hospitalisation, less hospitalisation expenditure (both p<0.00001), less pain and better quality of life. Short-term morbidity and readmission rates did not differ between treatments. No incidents of death occurred during the short-term follow-up period. Conclusions In patients with gastric cancer undergoing gastrectomy, the FTS pathway reduces the length and cost of postoperative hospitalisation while maintaining short-term morbidity, readmission and mortality rates comparable with those of conventional care.

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