Age, complications influence death after colon cancer surgery

CHICAGO — Perioperative complications increased the 1-year risk for death after colon cancer surgery among patients of all ages, according to study results presented at the ASCO Annual Meeting.

The heightened risk caused by complications extended beyond the 30-day postoperative period, and nearly one-quarter of patients aged older than 65 years died of cardiovascular disease.

Few studies have focused on age-related differences in the rate and cause of death beyond the postoperative period among patients undergoing colectomy.

“Most of the previous studies looking at long-term outcomes have focused on oncologic endpoints, such as RFS, to analyze the effects of different treatment regimens,” Christopher Thomas Aquina, MD, MPH, surgical resident at University of Rochester Medical Center and research fellow at Surgical Health Outcomes & Research Enterprise, told HemOnc Today. “This research has been critical in improving outcomes for patients, but it has not traditionally accounted for other factors influencing OS.”

Aquina and colleagues accessed the New York State Cancer Registry and Statewide Planning and Research Cooperative System to identify patients who underwent colectomy for stage I to stage III colon adenocarcinoma between 2004 and 2011 (n = 26,420).

The researchers categorized patients by age group — younger than 65 years, 65 years to 74 years, and 75 years or older — and the by occurrence of major complications. They then compared age groups with cause of death 1 year after surgery.

Overall, 3.3% of patients died within 30 days of surgery, and 11.6% died within 1 year. Mortality varied by age group (< 65 years, 3.8%; 65-74 years, 8.3%; 75 years, 18.8%).

A greater percentage of older patients experienced a major complication (< 65 years, 23.3%; 65-74 years, 29.9%; 75 years, 38.2%). Postoperative complications significantly increased the risk for death at 1 year across all age groups, including for those aged older than 65 years (6.4% vs. 1.9%) 65 to 74 years (12.8% vs. 3.8%) and 75 years or older (22.4% vs. 9.2%; P < .0001 for all).

Although colon cancer was the leading cause of death in all cohorts, a greater proportion of younger patients died of disease than older patients (< 65 years, 58% vs. 75 years, 43.9%).

However, the risk for death caused by cardiovascular disease increased with age. Four hundred twenty-nine patients (27.8%) aged 75 years or older died of cardiovascular disease, compared with 9.3% (n = 21) of patients aged younger than 65 years and 20.7% (n = 83) of patients aged 65 years to 74 years.

“The major focus following surgery typically involves preventing cancer recurrence through close oncologic follow-up and appropriate use of chemotherapy,” Aquina said. “Traditionally, there has not been as much focus placed on the management of the patient's other comorbidities, which may be driving the higher rates of death from cardiovascular disease. Older patients are more likely to have higher rates of cardiovascular disease and a higher overall level of comorbidity burden compared to younger patients.”

Aquina told HemOnc Today that he hopes these data will lead to stronger collaborations between surgeons and medical oncologists.

“We hope that this work emphasizes the need for greater collaboration with our colleagues in geriatric oncology to allow for a more nuanced preoperative assessment including a comprehensive geriatric assessment when appropriate,” Aquina said. “We feel that multidisciplinary support will help improve the delivery of care to older patients with colon cancer.” – by Cameron Kelsall

Reference:

Aquina CT, et al. Abstract 10012. Presented at: ASCO Annual Meeting; June 3-7, 2016; Chicago.

Disclosure: Aquina reports no relevant financial disclosures. Other researchers report consultant roles with Seattle Genetics and UpToDate.