Outcomes reported in elective colorectal cancer surgery research for older patients: A scoping review

IF 2.9 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Colorectal Disease Pub Date : 2024-10-04 DOI:10.1111/codi.17177

Hepsi H. Xavier, Yagnaseni Bhattacharya, Amudha Poobalan, Miriam Brazzelli, George Ramsay

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Abstract

Aim

Colorectal cancer rates are increasing in older populations, who often have comorbidities and face higher surgical risks and mortality rates. Therefore, surgical outcomes, such as 5-year mortality rates, may not be appropriate, necessitating a focus on postoperative quality of life. However, determining optimal postoperative outcome measures for older colorectal cancer patients poses a challenge. This scoping review aimed to explore currently available data describing postoperative outcomes used to assess older patients undergoing elective colorectal cancer surgery.

Method

We conducted a comprehensive literature search of major electronic databases from inception to March 2023. Studies exploring frail or older individuals with colorectal cancer undergoing elective surgical procedures, and which reported postoperative outcomes, were included. Outcomes were categorized as surgery-specific versus person-centred and summarized using narrative synthesis. The type and rate of surgery-specific outcomes were tabulated.

Results

Of 1366 identified citations, 16 studies focused on person-centred outcomes and 66 reported exclusively on surgery-specific outcomes. Nine ‘person-centred outcome’ studies reported discharge destination, primarily home discharge. Postoperative delirium ranged from 8.2% to 18.1% in six studies. Four studies explored geriatric syndromes, three analysed activities of daily living, and three studies reported significant quality of life improvement. The 66 ‘surgery-specific outcome’ studies assessed mortality (N = 61); length of stay (N = 40); postoperative complications (N = 47); readmission (N = 18); reoperation (N = 16); and survival (N = 42).

Conclusion

Person-centred outcomes are underreported, but crucial for guiding patient management. Older patients require adequate information about their postoperative recovery period to enhance wellbeing. Future research must address this gap to improve care for older people undergoing elective colorectal cancer surgery.

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老年患者选择性结直肠癌手术研究的结果报告：范围综述。

目的：老年人患结直肠癌的比例越来越高，他们通常有合并症，面临的手术风险和死亡率也更高。因此，手术结果（如 5 年死亡率）可能并不合适，因此有必要关注术后生活质量。然而，确定老年结直肠癌患者的最佳术后疗效指标是一项挑战。本范围综述旨在探索目前可用的数据，这些数据描述了用于评估接受择期结直肠癌手术的老年患者的术后效果：我们在主要电子数据库中进行了全面的文献检索，检索时间从开始到 2023 年 3 月。方法：我们对从 2023 年 3 月开始的主要电子数据库进行了全面的文献检索，纳入了对接受择期手术治疗的体弱或老年结直肠癌患者进行探讨并报告术后结果的研究。研究结果分为手术特异性结果和以人为本的结果，并采用叙事综合法进行总结。结果：结果：在1366个已确定的引文中，16项研究侧重于以人为本的结果，66项研究仅报告了手术特异性结果。9项 "以人为本的结果 "研究报告了出院目的地，主要是家庭出院。在六项研究中，术后谵妄的发生率从8.2%到18.1%不等。四项研究探讨了老年综合症，三项研究分析了日常生活活动，三项研究报告了生活质量的显著改善。66项 "特定手术结果 "研究评估了死亡率（61项）、住院时间（40项）、术后并发症（47项）、再入院（18项）、再次手术（16项）和存活率（42项）：结论：以人为本的结果报告不足，但对指导患者管理至关重要。老年患者需要充分了解术后恢复期的相关信息，以提高他们的健康水平。未来的研究必须弥补这一不足，以改善对接受择期结直肠癌手术的老年人的护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.