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2007 Program and Abstracts | 2007 Posters
Can Elderly Patients Tolerate My Surgical Treatment? a Practical Approach to a Common Dilemma
Giampaolo Ugolini, Isacco Montroni*, Giancarlo Rosati, Simone Zanotti, Alessio Manaresi, Luca Giampaolo, Mario Taffurelli
General Surgery, Policlinico S. Orsola- Malpighi Bologna, Bologna, Italy

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.

*Fisher's exact test


2007 Program and Abstracts | 2007 Posters
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