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Multidisciplinary management and optimization of frail or high surgical risk patients in colorectal cancer surgery: Prospective observational analysis.
- Source :
-
Cirugia espanola [Cir Esp (Engl Ed)] 2020 Aug - Sep; Vol. 98 (7), pp. 389-394. Date of Electronic Publication: 2020 Feb 22. - Publication Year :
- 2020
-
Abstract
- Introduction: Frailty is associated with greater postoperative morbidity and mortality. Individualized multidisciplinary management of these patients can improve the quality of care. The objectives of this study are to determine the percentage of frail patients with colorectal cancer in our population, and to describe the morbidity and mortality associated with surgery and the evolution of palliative treatment.<br />Methods: A prospective, observational study of patients with surgical colorectal cancer (February 1, 2018-April 30, 2019). Frail patients were screened and classified according to degrees of frailty. Therapeutic decision-making (surgery or palliative treatment) was determined by the degree of fragility and explicit will of the patient. Postoperative comorbidities were analyzed (according to Clavien-Dindo and Comprehensive Complication Index), as were mortality and oncological follow-up.<br />Results: The study included 193 patients with surgical colorectal cancer, with a mean age of 74 years (44-92). Screening identified 46 frail patients (24%), with a mean age of 80 years (57-92). Twenty-two patients were optimized and underwent surgery (48%), with a mean age of 78 years (57-89). Relevant adverse effect rate was 27.7% (4 grade iva adverse effects, one ivb and one v, according to Clavien-Dindo). Comprehensive Complication Index was 17.5. Palliative treatment was administered in 24 patients (52%), with a mean age of 82 years (59-92). Mean follow-up was 7.8 months. There were 2 deaths due to disease progression (8.3%), 5 re-consultations due to complications of colorectal cancer (20.1%).<br />Conclusions: The multidisciplinary and individualized management of frail patients with colorectal cancer is key to improve the quality of care in the treatment of this patient group.<br /> (Copyright © 2020 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Colorectal Neoplasms epidemiology
Colorectal Neoplasms mortality
Comorbidity
Female
Follow-Up Studies
Frailty surgery
Geriatrics statistics & numerical data
Humans
Interdisciplinary Communication
Male
Middle Aged
Postoperative Complications epidemiology
Postoperative Complications mortality
Prospective Studies
Quality of Health Care standards
Risk Factors
Colorectal Neoplasms surgery
Frail Elderly statistics & numerical data
Frailty epidemiology
Palliative Care methods
Subjects
Details
- Language :
- English; Spanish; Castilian
- ISSN :
- 2173-5077
- Volume :
- 98
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Cirugia espanola
- Publication Type :
- Academic Journal
- Accession number :
- 32093873
- Full Text :
- https://doi.org/10.1016/j.ciresp.2020.01.004