Urgente darmresecties bij ouderen met coloncarcinoom

Abstract

Objective: The aim of the study was to identify risk factors for postoperative mortality in patients undergoing surgery for colon cancer. We looked specifically at patients ≥ 80 years of age in whom a nonelective colon cancer resection was performed. Study Design: Observational study. Methods: We included data from 6,161 patients who underwent colon cancer surgery in 2010 in a Dutch hospital; a nonelective colon cancer resection was performed in 1,172 of these patients. Risk factors for postoperative mortality were identified using a multivariate logistic regression analysis. We studied elective and nonelective intestinal resections separately in different age groups. Results: Mortality in the total study population was 4.9%. Mortality increased with age in patients who underwent either elective or nonelective intestinal resection. For patients ≥ 80 years of age who underwent nonelective intestinal resection, each additional risk factor doubled the mortality risk. In patients aged ≥ 80 years with an American Society of Anesthesiologists classification of class ≥ 3 who underwent a left hemicolectomy or 'other' intestinal resection, the postoperative mortality rate was 41%; in patients of the same age without additional risk factors this was 7%. CONCLUSIONS In patients ≥ 80 years of age with 2 or more additional risk factors, nonelective intestinal resection should be considered a high-risk procedure with a mortality risk of up to 41%. This result can be used in clinical decision making concerning treatment and in providing information for patients and their families.