Early Postoperative Mortality Among Patients Aged 75 Years or Older With Stage II/III Rectal Cancer
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Background: Elderly patients with rectal cancer have been excluded from randomized studies, thus little is known about their early postoperative mortality, which is critical for informed consent and treatment decisions. This study examined early mortality after surgery in elderly patients with locally advanced rectal cancer (LARC). Methods: Using the National Cancer Database, we identified patients aged ≥75 years, diagnosed with clinical stage II/III rectal cancer who underwent surgery in 2004 through 2015. Descriptive analyses determined proportions and trends and multivariable logistic regression analyses were performed to determine factors associated with early mortality after rectal cancer surgery. Results: Among 11,794 patients with rectal cancer aged ≥75 years, approximately 6% underwent local excision and 94% received radical resection. Overall 30-day, 90-day, and 6-month postoperative mortality rates were 4.2%, 7.8%, and 11.5%, respectively. Six-month mortality varied by age (8.4% in age 75–79 years to 18.3% in age ≥85 years), and comorbidity score (10.1% for comorbidity score 0 to 17.7% for comorbidity score ≥2). Six-month mortality declined from 12.3% in 2004 through 2007 to 10.2% in 2012 through 2015 (Ptrend=.0035). Older age, higher comorbidity score, and lower facility case volume were associated with higher 6-month mortality. Patients treated at NCI-designated centers had 30% lower odds of 6-month mortality compared with those treated at teaching/research centers. Conclusions: Six-month mortality rates after surgery among patients aged ≥75 years with LARC have declined steadily over the past decade in the United States. Older age, higher comorbidity score, and care at a low-case-volume facility were associated with higher 6-month mortality after surgery. This information is necessary for informed consent and decisions regarding optimal management of elderly patients with LARC.
Submitted August 19, 2019; accepted for publication October 31, 2019.
Previous presentation: Preliminary findings were presented at the 2019 ASCO Annual Meeting; June 3, 2019; Chicago, Illinois. Abstract 248295.
Author contributions: Study concept and design: All authors. Data acquisition: Sineshaw. Data interpretation: All authors. Drafting of manuscript: Sineshaw, Mitin. Critical revision of manuscript for important intellectual content: All authors. Administrative, technical, or material support: Sineshaw, Yabroff, Jemal. Study supervision: Sineshaw, Yabroff, Jemal, Mitin.
Disclosures: Dr. Mitin has disclosed that he has received grant/research support from Novocure, Inc; is a scientific advisor for Novocure and Janssen; and receives royalties from UpToDate, Inc. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This work was supported by the American Cancer Society Intramural Research (no grant number applicable to H.M.S., Y.K.R., and A.J.).
Disclaimer: The data used in the study are derived from a limited data set of the National Cancer Database. The authors acknowledge the efforts of the American College of Surgeons, the Commission on Cancer, and the American Cancer Society in the creation of the National Cancer Database. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used, or the conclusions drawn from these data by the authors.
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