Factors Affecting Postoperative Early-term Mortality and Anastomotic Leakage in Geriatric Colorectal Cancer Patients

Abstract

AIM: In terms of early-term mortality, there may be variability in terms of factors belonging to age groups. While some risk factors apply to all patients undergoing colorectal cancer surgery, some factors may come to the fore in terms of age. There have been very few studies on factors that increase the risk of early-term mortality, especially for geriatric patients. It was aimed to compare factors influencing prognosis and mortality within the first 30 postoperative days between geriatric patients and those <65 years of age, and to identify factors that increase the risk of anastomotic leakage and early-term mortality, particularly in geriatric patients. 

METHODS: Clinical, laboratory, and pathology findings from 341 patients (186 geriatric) who underwent surgery for colorectal cancer between January 2016 and December 2019 were collected and analyzed. In terms of categorical variables, comparisons between groups were made with Pearson's Chi Square test and Fisher's Exact Test. Risk coefficients of variables in terms of anastomotic leakage and early-term mortality were determined by logistic regression analysis. The results were evaluated within the 95% Confidence interval, and p < 0.05 values were considered significant. 

RESULTS: Anastomotic leakage was detected in 7% of patients, and 6.2% of the patients died within the first 30 postoperative days. The 30-day postoperative mortality rate was significantly higher in geriatric patients with hypertension (p = 0.003), those undergoing emergency surgery (p = 0.007), those with stage 4 tumors (p < 0.001), those with ostomy-related complications (p = 0.042), those who developed intraabdominal abscess or peritonitis (p < 0.001), those with respiratory failure (p = 0.009), and those with perforation (p = 0.001). In patients <65 years of age, groups stratified by these variables did not differ significantly in terms of early-term mortality rate (p > 0.05 for each). 

CONCLUSIONS: These findings show that lack of bowel preparation and development of intraabdominal abscess/peritonitis significantly increase early-term mortality rates in both <65 and geriatric patients. Additionally, hypertension, emergency surgery, advanced tumor stage, development of ostomy-related complications, respiratory failure, and perforation significantly increase early-term mortality solely in geriatric patients.