Feasibility of a tailored ERAS programme in octogenarian patients undergoing minimally invasive surgery for colorectal cancer.

Abstract

BACKGROUND:

The enhanced recovery after surgery (ERAS) is nowadays a widely accepted multimodal programme of care in colorectal surgery, but still there is some reluctance in its application to very elderly patients.

AIM:

The aim of this study is to investigate short-term outcomes of laparoscopic resection for colorectal cancer in octogenarian patients within the ERAS programme.

METHODS:

Data on 162 consecutive patients aged ≥ 80 years receiving elective minimally invasive colorectal resections within ERAS programme were collected in a multicentre, retrospective database in the period 2008-2017 in Italy. Univariate and multivariate analyses were performed to assess possible risk factors for poor clinical outcomes.

RESULTS:

The postoperative minor morbidity rate (Clavien-Dindo 1 and 2) was 25.9%. The incidence of postoperative major morbidity rate (severe medical and surgical complications defined as Clavien-Dindo 3 and 4) accounted 6.1% and only 1.8% had an anastomotic leakage. Reoperation rate was 5.5%, perioperative 30-day mortality was 1.8%, and 30-day readmission rate was 6.8%. On average, patients were released after 6 days. A univariate analysis showed that possible risk factors for severe medical complications were: low preoperative albumin level, high Charlson Age Comorbidity Index Score and number of days in the intensive care unit (ICU); risk factors for severe surgical complications were: low preoperative albumin level; risk factors for late hospital discharge were: multivisceral resections, number of days in ICU and body mass index (BMI) > 25 kg/m2. The multivariate analysis confirmed a low level of preoperative albumin and a longer ICU stay as independent risk factors for both postoperative severe surgical complications and late hospital discharge.

DISCUSSION:

The minimal invasive nature of the laparoscopic approach together with a multimodal analgesia therapy, the early resumption to oral diet and mobilisation could minimize the surgical stress and play an essential role in order to reduce medical morbidity in high-risk patients.

CONCLUSION:

Colorectal surgery within ERAS programme in octogenarians is a safe and flexible treatment in high-volume centres.

• Authors: N Depalma, D Cassini, M Grieco, V Barbieri, A Altamura, F Manoochehri, M Viola, G Baldazzi
• Journal: Aging clinical and experimental research (Aging Clin Exp Res) Vol. 32 Issue 2 Pg. 265-273 (Feb 2020) ISSN: 1720-8319 [Electronic] Germany
• PMID: 30982218 (Publication Type: Journal Article)

Topics

• Aged, 80 and over
• Colorectal Neoplasms (surgery)
• Digestive System Surgical Procedures (adverse effects)
• Elective Surgical Procedures (adverse effects)
• Enhanced Recovery After Surgery
• Feasibility Studies
• Female
• Humans
• Italy
• Length of Stay
• Male
• Minimally Invasive Surgical Procedures (adverse effects)
• Postoperative Complications (etiology)
• Postoperative Period
• Reoperation
• Retrospective Studies
• Risk Factors