Elderly Colon Cancer Patients Research Articles

Abstract CT222: Colon cancer in elderly patients: Retrospective analysis of targeted therapy era

Abstract Purpose: This study was conducted in order to evaluate the response rate, progression free survival (PFS), safety and prognostic factors of targeted combination chemotherapy in colon cancer patients older than 65 years. Methods: This retrospective study included 69 elderly patients (≥ 65 years) with metastatic Colon cancer who have not received palliative chemotherapy before. All patients were histologically confirmed colon cancer at Keimyung university Dongsan medical center from Jan 2007 to July 2017. All recruited patients received either cetuximab or bevacizumab every 2 weeks. Results: The median age was 73.35 (65-87) and 33 were right side, 32 were left, 2 were transverse and rest of 2 patients were multiple primary sites. Bevecizumab was administerd to 42 patients (60.9%) and cetuximab was administered to 27 patients (39.1%). Complete response was 9 patients (13%), partial response was 23 (33.3%) and progression disease was 9 (13.0%). Overall response rate was 31 (46.4%) and disease control rate was 42 (62.3%). Progression free survival was 12.038 ±1.565 months (95% CI: 8.97~12.12). The most common hematologic side effects was anemia with grade 3/4 in 14 (20.3%). Systemic chemotherapy with targeted agents were moderately tolerated with grade 3/4 neutropenia 40 (57.9%). Conclusion: In elderly patients with colon cancer, clinical outcomes showed similar results compared with prior clinical trials. Preventing such complications may improve survival. Citation Format: JIN YOUNG KIM, Sojin Shin, Mi Hwa Heo, Kang Kook Lee. Colon cancer in elderly patients: Retrospective analysis of targeted therapy era [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT222.

Laparoscopic complete mesocolic excision with D3 lymph node dissection for right colon cancer in elderly patients

Complete mesocolic excision (CME) with D3 lymph node dissection is considered an oncological surgery for right colon cancer. However, there is still controversy for extensive oncological surgery in elderly patients. The aim of this study is to evaluate the safety and oncological outcomes of laparoscopic CME with D3 lymph node dissection for right colon cancer in elderly patients. Patients who underwent laparoscopic right colectomy, from 2004 to 2014, were divided into Groups A (age ≥ 70 years, n = 80) or B (age < 70 years, n = 127). Short and long-term outcomes were analysed. Basic demographics and short-term surgical outcomes were similar between groups. Among pathological outcomes, the mean number of harvested lymph nodes was significantly less in Group A. Adjuvant chemotherapy refusal rate was significantly higher in Group A. Overall and recurrence-free survival were similar between groups. We found laparoscopic CME with D3 lymph node dissection is a safe and feasible surgical option for right colon cancer in elderly patients.

P-281 Colon cancer in elderly patients: Experience of the Medical Oncology Department of CHU Hassan II Fez

This is a retrospective study of patients over the age of 70 with colonic cancer who were followed up and treated in the Department of Medical Oncology at Hassan II University Hospital in Fez from January 2015 to June 2019. Overall, 15.38% of patients aged over 70 years were listed among the 247 cases of histologically confirmed colon cancer collected over a period of 4 years. The median age was 79.44 years (range, 70-103 years), with a slight male predominance of 57%. In all, 28% of patients had hypertension-type comorbidities and diabetes, and only 1 patient had well-controlled prostate cancer under medical castration. Colonic adenocarcinoma was the histological type in all cases. Overall, 65% of patients were metastatic with a predilection for the liver and the lungs as sites of metastasis. RAS status was sought only in 7.69% of cases and was mutated. A total of 23.07% of patients had received mono-chemotherapy based on intravenous or oral fluoropyrimidines; 53.84% received bi-chemotherapy based on 5FU in combination with irionotecan or oxaliplatin; and 61.53% received bevacizumab in combination with chemotherapy. In all, 8.69% of patients were put on maintenance after a partial response to the first line of treatment with good tolerance. Only 19.23% were able to receive a second therapeutic line. Overall, 11.53% were lost to follow-up after diagnosis and 11.53% who had a PS of 4 were placed in supportive care. Of the patients, 31.57% were operated without any postoperative complications. One-quarter were classified as stage II with the achievement of microsatellite status, which was stable in 66.6% and unstable in 33.3%. Overall, 45.45% had received 5FU bi-chemotherapy whereas 36.36% had received only a mono-chemotherapy. Of the patients who received adjuvant chemotherapy, 22.2% are currently under good control. The safety profile was generally good without any grade 3 or 4 toxicity. The treatment of elderly patients with colon cancer remains similar to that of young people. However, their treatment must be adapted according to their physiological conditions and their comorbidities within the framework of a multidisciplinary collaboration for a better quality of life.

Nomogram predicting cancer-specific survival in elderly patients with stages I–III colon cancer

Aim: This study aims to establish and validate an effective nomogram to predict cancer-specific survival (CSS) in elderly patients with stages I–III colon cancer.Methods: The data of elderly colon cancer patients with stages I–III were enrolled from the Surveillance, Epidemiology, and End Results database (SEER) between 2010 and 2015. The eligible patients were randomly divided into a training cohort and a validation cohort (ratio 1:1). All predictors of cancer-specific survival were determined by Cox regression. The concordance index (C-index) and calibration curves were used for validation of nomograms. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit of the nomogram.Results: Cox hazard analysis in the training cohort indicated that grade, tumor stage, node stage, colectomy, and CEA were independent predictors of CSS. Nomogram was constructed based on these predictors. The C-index of nomograms for CSS was 0.728 (95%CI: 0.7133–0.7427), and were superior to that of AJCC TNM Stage (C-index: 0.625, 95%CI: 0.6093–0.6406). The calibration curves showed satisfactory consistency between actual observation and nomogram-predicted CSS probabilities. The validation cohort demonstrated similar results. The DCA showed high net benefit of nomogram in a clinical context. The population was divided into three groups based on the scores of the nomogram, and the survival analysis showed that this prognostic stratification was statistically significant (p < 0.01).Conclusion: The nomograms showed significant accuracy in predicting 1-, 3-, and 5-year CSS in elderly patients with stages I–III colon cancer and may be helpful inpatient counseling clinical decision guidance.

Development of expert system that improve the decision-making process with an emphasis on health-related quality of life in elderly patients with a colon cancer.

113 Background: Health-Related Quality of Life (HRQoL) is an important issue for elderly patients with colon cancer. We created the expert system which allows to predict low level of HRQoL and accessed it’s quality by using several simulation studies. Methods: We performed a systematic review to figure out the known factors associated with low level of HRQoL in elderly colon cancer patients. The searches were performed in PubMed. We accessed the possible impact of several factors affecting HRQoL, including symptoms, comorbidities and treatment toxicity. All relevant factors were included in prediction model. We assigned the different weights to different factors based on evaluation of clinical studies to develop the logistic regression and Markov stochastic model later. As we needed a binary dependent variable we performed the ROC analysis to figure out an optimal cutoff of HRQoL. Then we simulated a partly virtual dataset based on elderly colon cancer patients diagnosed in Davidovskiy Hospital to evaluate the prediction model quality. All statistical calculations were performed in RStudio. The simulation part was performed using simFrame R package. Results: Twenty two studies with a total number of 2516 patients were included in our systematic review. The 39 factors with different weights were included prediction model with different weights assigned. The weights range varied from 1 to 18.6. The adjusted proportion of summary score's variance (R2 ) varied from 0.09 to 0.47 in univariate analysis. The final logistic regression model quality was moderate: the Nagelkerke R-square coefficient was 57.9. However, the developed model showed a 76% sensitivity and 61% specificity in predicting of lower HRQoL level. Conclusions: Our prediction model allows to prospectively manage of elderly colon cancer patients, making the emphasis on HRQoL. However, the present study has some restrictions: simulation nature of internal validation, possible underestimating of the rare events impact. The long-term comprehensive approach with external validation using large real data analysis is needed to evaluate our prediction model.

Emergency Surgery for Obstructive Colon Cancer in Elderly Patients: Results of a Multicentric Cohort of the French National Surgical Association.

Although elderly patients constitute most of the patients undergoing surgery for obstructed colon cancer, available data in the literature are very limited. The purpose of this study was to assess the management and outcomes of elderly patients treated for obstructed colon cancer. This was a multicenter, retrospective cohort study. Between 2000 and 2015, 2325 patients managed for an obstructed colon cancer in member centers of the French National Surgical Association were identified. Data were collected by each center on a voluntary basis after institutional approval. Bowel obstruction was defined clinically and confirmed by imaging. Three age groups were defined, including patients <75 years, 75 to 84 years, and ≥85 years. Postoperative and oncologic results in elderly patients with an obstructed colon cancer were measured. Relative survival was calculated as the ratio of the overall survival with the survival that would have been expected based on the corresponding general population. A total of 302 patients (13%) underwent colonic stent insertion, and 1992 (87%) underwent surgery as emergency procedure. A total of 2294 patients were analyzed (<75 y, n = 1200 (52%); 75-84 y, n = 650 (28%); and ≥85 y, n = 444 (20%)). Elderly patients were more likely to be women (p < 0.0001), to have proximal colon cancer (p < 0.0001), and to have a higher incidence of comorbidities (p < 0.0001). The use of colonic stent or the type of surgery was identical regardless of age. In patients with resected colon cancer, elderly patients had less stage IV disease (p < 0.0001). The absence of tumor resection (p < 0.0001) and definitive stoma rate increased with age (p < 0.0001). Postoperative mortality and morbidity were significantly higher in elderly patients (p < 0.0001), but surgical morbidity was similar across age groups (p = 0.60). Postoperative morbidity was correlated to the 6-month mortality rate in elderly (p < 0.0001). Overall and disease-free survivals were significantly lower in more elderly patients (p < 0.0001) but relative survival was not (p = 0.09). It is quite difficult to know how to interpret these data as a whole, given the inherent bias in the study population, lack of ability to stratify by performance status, and long study period duration. Elderly patients have high morbidity with lower survival in the highest age ranges of elderly subgroups. These data should be considered when deciding on an operative approach. See Video Abstract at http://links.lww.com/DCR/A964.

Laparoscopic colectomy after transcatheter aortic valve implantation in an elderly patient with obstructive descending colon cancer and severe aortic stenosis: a case report

BackgroundThe demand for laparoscopic colectomy is increasing due to greater number of elderly colon cancer patients, and it is important to evaluate existing comorbidities to ensure perioperative safety. Aortic stenosis (AS) is one of the most common heart diseases in the elderly, and elderly cancer patients with severe AS may be considered ineligible for optimal cancer treatment if they cannot endure surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve implantation (TAVI) has become a valid option in patients who are high risk for SAVR. We herein present the first case of an elderly cancer patient with severe AS who underwent laparoscopic colectomy after TAVI.Case presentationAn 87-year-old woman with a history of multiple cardiovascular diseases was diagnosed with obstructive descending colon cancer and initially underwent colonic stenting. However, as preoperative echocardiography revealed severe AS, she underwent TAVI prior to the colectomy to reduce perioperative risk. TAVI was chosen instead of SAVR due to high SAVR mortality risk, and laparoscopic colectomy was performed 22 days after TAVI. Her postoperative course was uneventful, and she was discharged 14 days later without any deterioration in general condition. No recurrence was observed at more than 1 year, even without adjuvant therapy.ConclusionTAVI facilitated subsequent laparoscopic colectomy in an elderly cancer patient with severe AS. Our case report shows that TAVI may enable further cancer treatment even in patients with severe AS, who may otherwise be considered not suitable for such treatments.

Current Treatment Strategies for Elderly Patients with Metastatic Colon Cancer.

Colon cancer is one of the most common cancers in the United States and is expected to rise as the prevalence of colon cancer is increasing with increasing aging population. Though some studies have shown benefits of chemotherapy in the elderly population, however, they are also at risk of drug toxicities. We searched major search engines including PubMed, Medline and EMBASE and reviewed articles published in the last 10 years. Here we present current treatment strategies available for the metastatic colon cancer in elderly patients.

The effect of adjuvant chemotherapy for stage III colon cancer in elderly patients.

611 Background: Adjuvant chemotherapy (ACT) has been recommended for stage III colon cancer patients in NCCN guidelines. However, the benefit of ACT is still controversial in elderly patients. Methods: We retrospectively included stage III colon cancer patients with aged over 70 that were operated between 2008 and 2015 in Tosei general hospital from Japan. We calculated 3 years recurrence rate and performed a multivariate analysis to estimate the risk of recurrence. The model was adjusted by including the following 7 confounders: Age, ECOG-PS (0-1 or ≥ 2), tumor site (right or left), T stage (T1-3 or T4 ), N stage (N1 or N2), pathological type (por-sig or other), and complete ACT (yes or no). No complete ACT was defined as discontinuation ACT and surgery alone. Results: 182 patients were identified (87 patients aged &lt; 70 and 95 patients aged ≥ 70). ACT was performed in 58 patients (61.1%) and complete rate was 67.2% in elderly patients. The median follow up was 36.0 months. 29 patients (30.0%) had relapse. 3 years recurrence rate was 24.3% and 37.8% with complete ACT or no complete ACT (p = 0.29). In multivariate analysis, N2 was only the risk of recurrence (HR 6.95, p &lt; 0.01). In further analysis, addition of oxaliplatin was significant risk factor of recurrence in elderly patients (HR 10.4, p &lt; 0.01). On the other hand, in young patients, no complete ACT was only risk of recurrence (p = 0.01). 3 years survival rate was 89.1% and 81.0% with complete ACT or no complete ACT (p = 0.27). Conclusions: The multivariate analysis showed that ACT did not reduce the risk of recurrence in elderly patients. Moreover, addition of oxaliplatin suggested not only futile but harmful in those patients. These results support the previous reports (MOSAIC study and PETACC-8 trial) that microsatellite instability and RAS status may affect the effect of oxaliplatin.

Effect of multimodal analgesia with diclofenac sodium on cognitive function following radical resection for colon cancer in elderly patients

Objective To evaluate the effect of multimodal analgesia with diclofenac sodium on cognitive function following radical resection for colon cancer in elderly patients. Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 65-80 yr, weighing 45-85 kg, scheduled for elective open sigmoidectomy under general anesthesia, were divided into control group and test group by a random number table method with 30 patients in each group.In test group, diclofenac sodium suppository was administrated rectally before surgery and placed at about 2 to 3 cm above the anal dentate line, diclofenac sodium suppository 50 mg was given at 2 h before surgery and 4 h after surgery, followed by administration once every 12 h until 2 days after surgery.Patient-controlled intravenous analgesia was performed after operation, dezocine 5 mg was intravenously injected when VAS score was more than 4 points within 48 h after surgery.The concentrations of serum interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) were measured by enzyme-linked immunosorbent assay before surgery (T0) and at 2, 6, 12, 24 and 48 h after surgery (T1-5). The postoperative requirement for rescue analgesia, postoperative analgesia satisfaction score, time of passing the first flatus and first postoperative off-bed time were recorded.Cognitive function was assessed at 1 day before surgery and 7 days after surgery, and the occurrence of postoperative cognitive dysfunction was recorded. Results Compared with control group, the serum concentrations of IL-6 at T2-5, IL-8 at T1-5 and TNF-α at T2-4 were significantly decreased, the requirement for rescue analgesia and incidence of postoperative cognitive dysfunction were decreased, and the time of passing the first flatus and first postoperative off-bed time were shortened in test group (P<0.05). Conclusion Diclofenac sodium for multimodal analgesia can improve cognitive function following radical resection for colon cancer in elderly patients. Key words: Diclofenac; Analgesia; Cognition disorders; Colonic neoplasms; Aged

Safety and Efficacy of Oxaliplatin Doublet Adjuvant Chemotherapy in Elderly Patients With Stage III Colon Cancer

BackgroundColon cancer is common in the elderly, but owing to under representation in clinical trials, the benefit of standard therapies is uncertain in this age group. We aimed to clarify the efficacy and complications of adjuvant oxaliplatin and fluoropyrimidine chemotherapy for patients 70 years and older with stage III colon cancer. Patients and MethodsAll patients with stage III colon adenocarcinoma were identified from an Australian cancer registry (2006-2013). Multivariable Cox hazard regression was used to determine prognostic factors for all-cause mortality. Chemotherapy complications were quantified using discontinuation rates, hospital admissions, and mortality for 12 months after starting chemotherapy. ResultsA total of 2164 patients fulfilled our inclusion criteria, including 1080 (49.9%) patients ≥ 70 years. Patients ≥ 70 years were less likely to receive adjuvant chemotherapy (60.7% vs. 89.6%) or oxaliplatin doublet chemotherapy (18.8% vs. 71.2%). Older patients receiving oxaliplatin were more likely to cease treatment early (18.7% vs. 7.6%) and require hospital admission (67.0% vs. 53.5%). The addition of oxaliplatin provided an overall survival benefit for patients < 70 years (hazard ratio, 0.44; 95% confidence interval, 0.3-0.6; P < .0001) and for patients ≥ 70 years (hazard ratio, 0.64; 95% confidence interval, 0.5-0.9; P = .005). ConclusionsDespite a modestly increased rate of hospital admission and early chemotherapy cessation, we demonstrate a persistent survival benefit for the addition of oxaliplatin to a fluoropyrimidine as adjuvant treatment for stage III colon cancer in elderly patients.

Survival benefit of lymph node dissection in surgery for colon cancer in elderly patients: A multicenter propensity score-matched study in Japan.

In surgery for elderly patients with colorectal cancer, it is unclear whether radical lymph node (LN) dissection safely offers a survival benefit. The aim of the study was to evaluate the impact of the LN yield in elderly patients undergoing surgery for colorectal cancer. The subjects were selected from a surgical database of 2065 patients aged ≥80 years old who underwent surgery for colorectal cancer at 41 hospitals in Japan between 2003 and 2007. The patients were divided into groups according to the number LN harvested: <12 and ≥12. Propensity scores were subsequently matched to balance the baseline characteristics. Of the 954 patients initially selected, 331 were in the <12 LN and 623 were in the ≥12 LN group. After cases were matched, 293 patients were allocated to each group, and all covariates were balanced. For short-term outcomes, the time for surgery was longer in the ≥12 LN group, but there was no significant difference in morbidity between the groups. Overall, relapse-free and cancer-specific survival rates were higher in the ≥12 LN group (P = 0.004, 0.001, and 0.02). In patients aged ≥80 years old with stage II-III colon cancer, harvesting ≥12 LN provides a survival benefit, and therefore, limited LN dissection is not recommended in these patients.

Treatment and Survival of Patients with Colon Cancer Aged 80 Years and Older: A EURECCA International Comparison.

Colon cancer in older patients represents a major public health issue. As older patients are hardly included in clinical trials, the optimal treatment of these patients remains unclear. The present international EURECCA comparison explores possible associations between treatment and survival outcomes in elderly colon cancer patients. National data from Belgium, Denmark, The Netherlands, Norway, and Sweden were obtained, as well as a multicenter surgery cohort from Germany. Patients aged 80 years and older, diagnosed with colon cancer between 2001 and 2010, were included. The study interval was divided into two periods: 2001-2006 and 2007-2010. The proportion of surgical treatment and chemotherapy within a country and its relation to relative survival were calculated for each time frame. Overall, 50,761 patients were included. At least 94% of patients with stage II and III colon cancer underwent surgical removal of the tumor. For stage II-IV, the proportion of chemotherapy after surgery was highest in Belgium and lowest in The Netherlands and Norway. For stage III, it varied from 24.8% in Belgium and 3.9% in Norway. For stage III, a better adjusted relative survival between 2007 and 2010 was observed in Sweden (adjusted relative excess risk [RER] 0.64, 95% confidence interval [CI]: 0.54-0.76) and Norway (adjusted RER 0.81, 95% CI: 0.69-0.96) compared with Belgium. There is substantial variation in the rate of treatment and survival between countries for patients with colon cancer aged 80 years or older. Despite higher prescription of adjuvant chemotherapy, poorer survival outcomes were observed in Belgium. No clear linear pattern between the proportion of chemotherapy and better adjusted relative survival was observed. With the increasing growth of the older population, clinicians will be treating an increasing number of older patients diagnosed with colon cancer. No clear linear pattern between adjuvant chemotherapy and better adjusted relative survival was observed. Future studies should also include data on surgical quality.

Adjuvant therapy for stage II and III colon cancer in elderly patients: NCDB analysis.

863 Background: Data on safety and efficacy of adjuvant chemotherapy for stage II and III colon cancer in elderly patients is area of controversy as these patients are underrepresented in clinical trials. We did a retrospective analysis of Medicare patients aged 70 or older with stage II and stage III colon cancer to investigate the adjuvant chemotherapy effect on colon cancer patients’ survival. Methods: Data was analyzed from 110, 993 men and women (≥ 70 years of age) registered in the National Cancer Database (NCDB) who were diagnosed with AJCC Stage II and Stage III colon cancer between 2004 and 2012 and had follow-ups to end of 2013. The primary predictor variable was adjuvant chemotherapy received, and overall survival was the outcome variable. Only patients with Medicare insurance were investigate for ease of analysis. Additional variables addressed and adjusted included gender, age, race, Charlson Comorbidity Index, the level of education, income, grade of tumor, distance traveled, facility type and diagnosing/treating facility. Results: The mean age was 79.5 years and SD was 5.9 years. In multivariate analysis, after adjusting for secondary predictor variables, receipt of adjuvant chemotherapy was a statistically significant predictor of overall survival of the stage II and stage III colon cancer. Relative to patients who did not receive adjuvant chemotherapy, the patients who got single agent adjuvant chemotherapy had 47.7% and those who were treated with multi agent chemotherapy had 49.8% decreased risk of mortality. There was no significant survival difference between single agent and multi agent adjuvant chemotherapy. Among the factors analyzed, age, gender, race, comorbidity index, diagnosing /treating facility and grade of tumor were found to be significant predictors of survival. Conclusions: Among the patients aged 70 years or older with stage II and stage III colon cancer, adjuvant chemotherapy lead to improved survival outcomes. However, survival difference between single agent vs multi agent adjuvant chemotherapy was not statistically significant.

PD-021 - Clinical impact of renal impairment on safety in elderly colon cancer patients receiving capecitabine plus oxaliplatin as adjuvant therapy; multicenter post-marketing surveillance study

PD-021 - Clinical impact of renal impairment on safety in elderly colon cancer patients receiving capecitabine plus oxaliplatin as adjuvant therapy; multicenter post-marketing surveillance study

Comparison of long-term outcome between hemicolectomy and partial colectomy in the elderly: a large population-based study.

Due to large progress has been achieved in surgical techniques, anesthesia and perioperative care, it is accepted that the very elderly colon cancer (CC) patient is not contraindication for surgery. However, it is a controversy that an extended or a less aggressive surgical approach should be performed for this population. Here, we identified 28110 CC patients aged ≥80 from Surveillance, Epidemiology, and End-Results (SEER) database. The surgical approaches included extended hemicolectomy (HC) and partial colectomy (PC). 5-year cancer specific survival (CSS) was obtained. Kaplan–Meier methods and Cox regression models were used to assess the correlations between prognostic factors and long-term survival. The 5-year CSS for patients treated with HC were 45.6%, which were similar to patients who received PC (44.8%), the survival difference has no statistical significance (P=0.087). The result following propensity score matching further confirmed long-term survival were equal between HC and PC. However, patients in AJCC T3/T4 stage and with tumor size ≥5cm could obtain survival benefit from the extended surgery. In conclusion, most of elderly CC patients could not obtain survival benefit from extended resection. Partial colectomy should also be considered as an alternative approach for this group of patients.

Comparative analysis of postoperative complications of right versus left hemicolectomy for colon cancer in elderly patients

Objectives To compare and analyze the postoperative complications of right versus left hemicolectomy for colon cancer in elderly patients aged 65 years and over. Methods 365 elder patients with colon cancer aged 65 years and over received first surgery in Beijing Hospital during January 2013 to June 2016, and were pathologically diagnosed with colon adenocarcinoma.The right hemicolectomy(RC)was with an ileocolic anastomosis, and the left hemicolectomy(LC)with a colocolic or colorectal anastomosis.The data of patients were analyzed retrospectively, and the incidence rate of postoperative complications was compared between the two groups. Results 181(49.6%)patients underwent RC, and 184(50.4%)received LC.The proportion of males was lower in RC group than in LC(49.2% vs.59.2%, χ2=3.726, P=0.048). The average age was higher in RC patients than in LC(75.6 vs.73.6 years, t=3.048, P=0.002). RC had a longer average length of postoperative hospital stay than LC(13.6±14.07)days vs.(10.7±8.07)days, t=2.386, P=0.018). RC had a higher incidence rate of postoperative complication than LC(33.1% vs.21.7%, χ2=5.972, P=0.015). According to the Clavien-Dindo classification of postoperative complications, the incidence rate of complications at level I was higher in RC than in LC(10.5% vs.4.9%, χ2=4.049, P=0.044). Conclusions For elderly patients with colon cancer, the age is more advanced in RC patients and has a longer length of postoperative hospital stay, and has more postoperative complications, especially level I postoperative complications. Key words: Colorectal neoplasms; Postoperative complications

Laparoscopic surgery for colon cancer in elderly patients

Laparoscopic surgery for colon cancer in elderly patients

Exploration of the Optimal Minimum Lymph Node Count after Colon Cancer Resection for Patients Aged 80 Years and Older.

The elderly colon cancer (CC) patients are increasing and represent a heterogeneous patient group. The objectives of this study were to identify the features of lymph node examination and to explore the optimal minimum lymph node count after CC resection for patients aged ≥80. Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 65719 CC patients in stage I-III between 2004 and 2012, 26.0% of patients were aged ≥80. The median node count decreased with increasing age, which were 25.5, 20.2, 17.8 and 16.9 for patients aged 20–39, 40–59, 60–79, and ≥80. The rate of ≥12 nodes and the rate of node positivity for patients aged ≥80 were obviously lower than younger patients. Using X-tile analysis, we determined 9 nodes as the optimal node count for patients aged ≥80. Then, we compared the 5-year cancer specific survival (CSS) between patients with ≥9 nodes and <9 nodes. The results showed the 5-year CSSs were improved for patients with ≥9 nodes. Furthermore, the rate of node positivity and survival under the 9-node measure were equal to 12-node measure. Therefore, the lymph node examination should be discriminately evaluated for elder patients, and 9-node measure was available for patients aged ≥80.

Single-port versus multi-port laparoscopic surgery for colon cancer in elderly patients.

The safety of single-incision laparoscopic surgery (SLS) in elderly patients with colorectal cancer has not been established. The aim of the current study was to compare the outcomes of SLS and multi-port laparoscopic surgery (MLS) and to assess the feasibility of SLS in colorectal cancer patients aged ≥70 years. A retrospective case-control study of colon cancer patients undergoing elective surgical intervention between 2011 and 2014 was conducted. A total of 129 patients with colon cancer underwent surgery and were included in the analysis. Data regarding patient demographics, surgical variables, oncological outcomes and short-term outcomes were evaluated for statistical significance to compare MLS (n=79) and SLS (n=50) in colon cancer patients. No significant differences were observed in patient characteristics. No case required re-admission within 30 days post surgery. The mean surgery times were similar for the MLS and SLS groups when cases with left and right hemicolectomies were combined (207.7 and 215.9 min, respectively; P=0.47). In addition, overall perioperative outcomes, including blood loss, number of lymph nodes harvested, size of the surgical margin and complications, were similar between these groups. Thus, we suggest that SLS can be performed safely in elderly patients with colon cancer.