Long-term results of emergency and planned surgical interventions performed for cancer of the left half of the colon in elderly and senile patients

Aim. To evaluate the 3-year disease-free survival (DFS) of elderly and senile patients who underwent emergency and planned operations for cancer of the colon left half.

Materials and methods. A retrospective cohort study with pseudorandomization included 514 patients divided into 2 groups. The 1^st group (n = 257) included patients who underwent emergency operations in surgical departments of clinical hospitals in Smolensk during the period from 10.10.2014 to 03.04.2023. Using the pseudorandomization procedure by comparison 1:1 the closest neighbor matching method, the 2nd group (n = 257) was formed from the database maintained prospectively which included patients having been operated routinely during the same period at the Smolensk Regional Oncological Clinical Dispensary. Inclusion criteria: 1) age 70–89 years; 2) patients with stage II–III cancer of the left colon, who underwent emergency surgery for acute obstructive obstruction, and patients with uncomplicated colon cancer having been operated in a planned manner; 3) histological type of tumor – adenocarcinoma. Non-inclusion criteria: 1) uncomplicated stage I colon cancer; 2) stage IV and/or locally advanced process; 3) emergency resection intervention in connection with other urgent complications; 4) non-epithelial malignancy, carcinoid. 3-year DFS was prospectively studied and factors of poor prognosis were identified.

Results. The groups were matched for sex, age, Charlson comorbidity index, cancer location, and stage. The Charlson comorbidity index in both groups was ≥7 in most observations.

Statistically significant differences in 3-year DFS were observed between the 2 study groups (p = 0.0014). The median follow-up in both groups was 30 months. In the subgroup analysis, statistically significant differences in 3-year DFS were found between patients who underwent emergency colonic resection at stage 1 according to the type of Hartmann operation (n = 145) and patients who developed decompression colostomy at the emergency stage, and stage 2, radical, was carried out after their condition was stabilized (n = 112) (p = 0.042). The median DFS for patients with Hartmann surgery was 24 months, patients with decompression colostomy was 28 months. Using a univariate analysis followed by confirmation in a multivariate analysis, factors of negative influence on the 3-year DFS indicators were determined: emergency resection intervention (hazard ratio (HR) 1.58; 95 % confidence interval (CI) 1.18–1.85; p < 0.001); local tumor status T4 (HR 1.22; 95 % CI 1.05–1.41; p < 0.001); step N+ (HR 1.36; 95 % CI 1.07–1.68; p < 0.001); resection R1 (HR 1.42; 95 % CI 1.04–1.51; p = 0.033); lymphovascular and perineural invasion (HR 1.55; 95 % CI 1.39–1.81; p < 0.001).

Conclusion. The 3-year DFS of elderly and senile patients with left-sided localization of colon cancer is affected by surgical tactics, especially in an emergency. In the case of acute obturation obstruction, the formation of decompression colostomy is associated with higher DFS rates comparable to those of elective surgery.

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