Older Age, Cardiovascular Comorbidities Increase Postsurgical Mortality in Patients with Gastrointestinal Cancers
“Comorbidity and older age are associated with early postoperative mortality after gastrointestinal cancer resection,” reported Yvette R. B. M. van Gestel, PhD, of the Eindhoven Cancer Registry and Comprehensive Cancer Center South (CCCS), in Eindhoven, The Netherlands, and coauthors. “High mortality rates were observed between 30 and 90 days after resection, so 30-day mortality is an underestimation of the true mortality. Consequently, it seems advisable that surgical teams should report all deaths that occur within 90 days after surgery.”
The study included analysis of 8,583 patients' files in the Netherlands Cancer Registry, who underwent gastrointestinal tract cancer surgery for malignancies stage I-III, diagnosed between 2005 and 2010. Mean age at diagnosis was 69.0 ± 11 years; 4,863 (56.7 %) were men.
Comorbidities were recorded in 5,910 (68.9%) of the patients.
“The 30-day mortality rates ranged from 0.5% for rectal cancer patients <65 years to 12.8% for gastric cancer patients ≥75 years,” Dr. van Gestel and coauthors wrote. “Patients with comorbidity who underwent esophageal tumor resection had the highest mortality rates, ranging from 8.4 % for 30-day to 12.0 % for 90-day mortality, while rectal cancer patients had the lowest rates, that is, 4.3–6.4 %, respectively.”
Patients undergoing gastric resection at age ≥75 years had significantly higher mortality rates than other patients 30 days after surgery (OR 2.94 [95% CI: 1.06-8.19]).
“For patients with esophageal cancer, the highest [30-day] mortality rates were observed for those with concomitant disease of the digestive tract (14.3%) and diabetes (11.4%),” they noted. “The presence of vascular disease led to the highest 30-day mortality after gastric resection (15.9%).”
Comorbidities should be considered before surgery to identify “patients' specific needs to optimally attenuate risk prior to surgery,” the authors concluded. “A less aggressive treatment approach may well be considered in these groups.”