EFFECT OF AGE ON MULTIVISCERAL RESECTION IN LOCALLY ADVANCED COLON CANCER
Swati Sonal*2, Yasmeen Z. Qwaider1, Chloe Boudreau2, Hiroko Kunitake2, Robert N. Goldstone2, Liliana G. Bordeianou2, Rocco Ricciardi2, Christy E. Cauley2, David L. Berger2
1Istishari Hospital, Amman, Amman, Jordan; 2Massachusetts General Hospital, Boston, MA
Introduction:
Multivisceral resection (MVR) can improve survival in locally advanced colorectal cancer (LACC). However, the effect of age on patients who require MVR in LACC has not been studied. Our objective is to compare outcomes of MVR in LACC between patients older and younger than 70 years.
Methods:
A prospective 2004-2018 database containing all patients with surgically resected colorectal cancers in a tertiary care institution was queried retrospectively. All Colon Cancer patients with pT4bN0-2M0 disease who underwent MVR were included in this analysis. Patients who underwent neoadjuvant therapy were excluded. Patients were divided based on being older or younger than 70 years. Categorical and continuous variables were analyzed using Fisher exact test and Wilcoxon signed rank test respectively. Overall survival (OS) and Disease-free survival (DFS) was compared using Kaplan Meier curves and log-rank tests. A Cox regression model was fit adjusting for age and Modified Charlson Comorbidity Index (mCCI, calculated without accounting for age and colon cancer).
Results:
Of 2504 records in the database, 49 patients were included in this analysis (older N=25 & younger N=24). The older group had higher mCCI at diagnosis (p=0.005), shorter follow up duration (p=0.004), and higher mortality (0.0001). There was no significant difference in the rates of intra-operative complication, 30-day readmission, R0 resection and recurrence between the two groups. The older group had similar 3-year DFS (68.8% vs 69.3%), however significantly worse 3-year OS as compared to the younger group (54.7% vs 82.4%). Kaplan Meier curves and log-rank tests showed a similar trend (OS: p<0.0001, DFS: p=0.86). On Cox regression, age ? 70 years (HR: 4.66, CI:1.81-12, p=0.001) & mCCI (HR: 1.47, CI:1.01-2.13, p=0.043) were independent prognostic factors for overall survival.
Conclusion:
Age per se does not affect disease-free survival in patients who undergo MVR. Rather, comorbidity appears to be the limiting factor in overall survival. The oncologic impact of an R0 MVR is similar regardless of chronologic age. Older patients should not be denied an MVR simply because of age but rather because of co-morbid factors.
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