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Inicio Cirugía Española (English Edition) Multidisciplinary Management and Optimization of Frail or High Surgical Risk Pat...
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Vol. 98. Issue 7.
Pages 389-394 (August - September 2020)
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Vol. 98. Issue 7.
Pages 389-394 (August - September 2020)
Original article
DOI: 10.1016/j.cireng.2020.07.013
Multidisciplinary Management and Optimization of Frail or High Surgical Risk Patients in Colorectal Cancer Surgery: Prospective Observational Analysis
Manejo multidisciplinar y optimización del paciente oncofrágil o de elevado riesgo quirúrgico en cirugía del cáncer colorrectal. Análisis observacional prospectivo
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Sheila Serra-Plaa,
Corresponding author
sheilaserrapla@gmail.com

Corresponding author.
, Anna Pallisera-Lloverasa, Laura Mora-Lópeza, Ana Granados Maturanob, Sebastian Gallardoc, Carmen del Pino Zuritaa,b,c, Xavier Serra-Aracila
a Unidad de Cirugía Coloproctológica, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
b Servicio de Medicina Interna, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
c Servicio de Medicina Paliativa, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
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Abstract
Introduction

Frailty is associated with greater postoperative morbidity and mortality. Individualized multidisciplinary management of these patients can improve the quality of care. The objectives of this study are to determine the percentage of frail patients with colorectal cancer in our population, and to describe the morbidity and mortality associated with surgery and the evolution of palliative treatment.

Methods

A prospective, observational study of patients with surgical colorectal cancer (February 1, 2018–April 30, 2019). Frail patients were screened and classified according to degrees of frailty. Therapeutic decision-making (surgery or palliative treatment) was determined by the degree of fragility and explicit will of the patient. Postoperative comorbidities were analyzed (according to Clavien–Dindo and Comprehensive Complication Index), as were mortality and oncological follow-up.

Results

The study included 193 patients with surgical colorectal cancer, with a mean age of 74 years (44–92). Screening identified 46 frail patients (24%), with a mean age of 80 years (57–92). Twenty-two patients were optimized and underwent surgery (48%), with a mean age of 78 years (57–89). Relevant adverse effect rate was 27.7% (4 grade iva adverse effects, one IVb and one V, according to Clavien–Dindo). Comprehensive Complication Index was 17.5. Palliative treatment was administered in 24 patients (52%), with a mean age of 82 years (59–92). Mean follow-up was 7.8 months. There were 2 deaths due to disease progression (8.3%), 5 re-consultations due to complications of colorectal cancer (20.1%).

Conclusions

The multidisciplinary and individualized management of frail patients with colorectal cancer is key to improve the quality of care in the treatment of this patient group.

Keywords:
Frailty
Geriatrics
Surgery in the elderly
Colorectal cancer
Resumen
Introducción

La fragilidad se asocia con una mayor morbimortalidad postoperatoria. El manejo multidisciplinar individualizado de estos pacientes puede mejorar la calidad asistencial. Los objetivos de este trabajo son conocer el porcentaje de pacientes frágiles con cáncer colorrectal en nuestra población y describir la morbimortalidad asociada a la cirugía y la evolución del tratamiento paliativo.

Métodos

Estudio observacional prospectivo de pacientes con cáncer colorrectal quirúrgico (1 de febrero del 2018-30 de abril del 2019). Cribado de paciente frágil y clasificación según grados de fragilidad. Decisión terapéutica (cirugía o tratamiento paliativo) según grado de fragilidad y voluntades explícitas del paciente. Análisis de comorbilidad postoperatoria (según Clavien-Dindo y Comprehensive Complication Index), mortalidad y seguimiento oncológico.

Resultados

Fueron visitados 193 pacientes con cáncer colorrectal quirúrgico, con una edad media de 74 años (44-92). Cribado: 46 pacientes frágiles (24%), con una edad media de 80 años (57-92). Se optimizó e intervino a 22 pacientes (48%), con una edad media de 78 años (57-89). Efectos adversos relevantes del 27,7% (4 efectos adversos grado iva, uno ivb y otro v, según Clavien-Dindo). Comprehensive Complication Index de 17,5. Tratamiento paliativo en 24 pacientes (52%), con una edad media de 82 años (59-92). Seguimiento medio de 7,8 meses, 2 muertes por progresión de la enfermedad (8,3%), 5 reconsultas por complicaciones del cáncer colorrectal (20,1%).

Conclusiones

El manejo multidisciplinar e individualizado del paciente frágil con cáncer colorrectal es clave para mejorar la calidad asistencial en el tratamiento de este grupo de pacientes.

Palabras clave:
Fragilidad
Geriatría
Cirugía en ancianos
Cáncer colorrectal

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