The aging population represents one of the most important medical challenges of this century. Colorectal Cancer (CRC) is the most common malignancy in the elderly. Age implies a reduced life expectancy and limited tolerance to stress. Careful evaluation of comorbidities is recommended before all treatment in order to minimize morbidity and mortality. The study tests the hypothesis that P-POSSUM (Porthsmouth-Physiologic Operative Severity Score for enUmeration of Morbidity & Mortality) and CR-POSSUM (ColoRectal Physiologic Operative Severity Score for enUmeration of Morbidity & Mortality) would be useful clinical auditing tools in colorectal cancer surgery for aged patients.
Methods: 177 consecutive CRC patients over 70 years of age who underwent emergency or elective surgery were prospectively entered in a comprehensive database from January 2003 to December 2005. Demographic information, disease severity, type of surgery, P-POSSUM and CR-POSSUM scores, detailed follow-up with a survey of 29 complications and 30 day mortality data were collected. The observed over expected morbidity and mortality rate was calculated.
Results: 99 patients (56%) were operated on urgently and 78 electively (44%). Mean age was 80.3 years (range 70-95). 75 patients had advanced disease (stage III and IV). In 36 patients a palliative procedure (without bowel resection) was performed; 113 patients underwent bowel resection with anastomosis while in 28 patients a stoma was created. All data with observed over expected morbidity and mortality rate are illustrated in the Table.
Conclusions: Our data confirm that surgical treatment for CRC in elderly people is associated with a significant risk of morbidity and mortality. P-POSSUM and CR-POSSUM are useful tools for predicting mortality in elderly patients. P-POSSUM significantly overestimated the risk of complications in every subgroup of patients. A more accurate tool for pre-operative assessment of elderly patients is probably needed to predict the post-surgical outcome. Quality of life assessment and other functional parameters should be considered in personalising treatment.
| Subgroups | Pts | Expected Morbidity P-POSSUM | Observed Morbidity | P* | Expected Mortality CR-POSSUM | Expected Mortality P-POSSUM | Observed Mortality | P* CR-POSSUM/P-POSSUM |
| Resection and anastomosis | 113 | 55.3% | 38.9% | <0.05 | 11.3% | 9.9% | 9 (7.9%) | <0.05/n.s. |
| Resection and stoma | 28 | 64.1% | 46.4% | <0.05 | 15.8% | 14.3% | 2 (7.1%) | <0.05/n.s. |
| Palliative | 36 | 67.9% | 50% | <0.05 | 16.6% | 12.7% | 8 (22.2%) | <0.05/<0.05 |
| Emergency | 99 | 71.1% | 48.5% | <0.05 | 18.1% | 16.3% | 14 (14.1%) | <0.05/n.s. |
| Elective | 78 | 44.2% | 34.6% | <0.05 | 6.6% | 4.7% | 5 (6.4%) | n.s./<0.05 |
| Total | 177 | 59.3% | 42.4% | <0.05 | 13.1% | 11.2% | 19 (10.7%) | <0.05/n.s. |
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