Surgical and non-surgical complications after colorectal cancer surgery in older patients: time-trends and age-specific differences

Abstract

Background: Trends of surgical and non-surgical complications among the old, older and oldest patients after colorectal cancer (CRC) surgery could help to identify the best target outcome to further improve postoperative outcome.Materials and methods: All consecutive patients >= 70 years receiving curative elective CRC resection between 2011 and 2019 in The Netherlands were included. Baseline variables and postoperative com-plications were prospectively collected by the Dutch ColoRectal audit (DCRA). We assessed surgical and non-surgical complications over time and within age categories (70-74, 75-79 and >= 80 years) and determined the impact of age on the risk of both types of complications by using multivariate logistic regression analyses. Results: Overall, 38648 patients with a median age of 76 years were included. Between 2011 and 2019 the proportion of ASA score >= 3 and laparoscopic surgery increased. Non-surgical complications signif-icantly improved between 2011 (21.8%) and 2019 (17.1%) and surgical complications remained constant (from 17.6% to 16.8%). Surgical complications were stable over time for each age group. Non-surgical complications improved in the oldest two age groups. Increasing age was only associated with non-surgical complications (75-79 years; OR 1.17 (95% CI 1.10-1.25), >= 80 years; OR 1.46 (95% CI 1.37-1.55) compared to 70-74 years), not with surgical complications. Conclusion: The reduction of postoperative complications in the older CRC population was predomi-nantly driven by a decrease in non-surgical complications. Moreover, increasing age was only associated with non-surgical complications and not with surgical complications. Future care developments should focus on non-surgical complications, especially in patients >= 75 years.(c) 2022 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.