Page 136 - Risk quantification and modification in older patients with colorectal cancer

Chapter 7
Abstract
Background: We implemented a multidisciplinary pre- and rehabilitation program for elderly patients (≥75 years of age) in a single centre consisting of prehabilitation, laparoscopic surgery and early rehabilitation with the intention to lower 1-year overall mortality.
Patients and methods: In this study, we compared all patients that underwent elective surgery for stage I-III colorectal cancer before and during development and after implementation of the program (2010-2011, 2012-2013 and 2014-2015). The primary endpoint was 1-year overall mortality, the secondary endpoint was 30-day postoperative outcome.
Results: Eighty-six consecutive patients were included in the study cohort and compared to 63 patients from 2010-2011 and 75 patients from 2012-2013. Patient characteristics were comparable; median age in the study cohort was 80.6. Seventy- three patients (85%) participated in the program, 54 (63%) of whom followed a prehabilitation program, 46 (53%) of whom were discharged to a rehabilitation center. Laparoscopic surgery increased over the years, from 70% to 83% in the study cohort. There was a trend in lower 1-year overall mortality: 11% versus 3% (p=0.08). There was a significant reduction in cardiac complications and the number of patients with a prolonged length of stay (p<0.01).
Conclusions: Multidisciplinary care for elderly colorectal cancer patients that includes prehabilitation and rehabilitation is feasible and may contribute to lower complications and reduced length of stay. This study did not show a clear benefit of implementing a comprehensive care program, including both prehabilitation and rehabilitation. Dedicated multidisciplinary care seems the key attributor to favourable outcomes of CRC surgery in elderly patients.
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