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Impact of intraoperative blood loss on morbidity and survival after radical surgery for colorectal cancer patients aged 80 years or older

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to assess the effect of intraoperative blood loss (IBL) on short- and long-term outcomes of colorectal cancer surgery for very elderly patients.

Methods

We acquired the data of consecutive patients aged 80 years or older who underwent elective radical surgery for stage I to III colorectal cancer between January 2003 and December 2007 in 41 institutions. The patients were divided into high and low IBL groups, and the differences in postoperative morbidity and survival between the two groups were primarily assessed. Eleven factors were treated as potential confounders in multivariate analyses.

Results

A total of 1554 patients were eligible for this study, with an age range of 80–103 years. Median IBL was 71 ml (interquartile range, 25 to 200 ml), and 412 patients had IBL ≥200 ml. Morbidity was 46 % among patients with IBL ≥200 ml, compared with 30 % among those with IBL <200 ml (p < 0.001). Patients with IBL ≥200 ml had worse overall survival rates and recurrence-free survival rates at 1, 3, and 5 years than those with IBL <200 ml. In multivariate analyses, IBL ≥200 ml was identified as an independent risk factor for postoperative adverse events (odds ratio (OR) 1.41, 95 % confidence interval (CI) 1.08 to 1.86), overall survival (hazard ratio (HR) 1.34, 95 % CI 1.04 to 1.72), and recurrence-free survival (HR 1.29, 95 % CI 1.03 to 1.62).

Conclusion

The degree of IBL is significantly associated with postoperative morbidity and survival in very elderly colorectal cancer patients.

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Acknowledgments

This study was supported in part by the Japanese Society for Cancer of the Colon and Rectum. The authors thank all members of the institutions belonging to the Japan Society of Laparoscopic Colorectal Surgery that participated in this multicenter study: Eiji Kanehira, Kunihisa Shiozawa (Ageo Central General Hospital); Hiroyuki Bando, Daisuke Yamamoto (Ishikawa Prefectural Central Hospital); Seigo Kitano, Masafumi Inomata, Tomonori Akagi (Oita University); Junji Okuda, Keitaro Tanaka (Osaka Medical College); Kosei Hirakawa, Kiyoshi Maeda (Osaka City University); Akiyoshi Kanazawa (Osaka Red Cross Hospital); Junichi Hasegawa, Junichi Nishimura (Osaka Rosai Hospital); Ichio Suzuka (Kagawa Prefectural Central Hospital); Shintaro Akamoto (Kagawa University); Yosuke Fukunaga, Hiroya Kuroyanagi (Cancer Institute Ariake Hospital); Masaki Naito (Kitasato University); Takashi Ueki (Kyushu University); Takashi Yamaguchi (Kyoto Medical Center); Yukihito Kokuba (Kyoto Prefectural University); Hirotoshi Hasegawa (Keio University School of Medicine); Norio Saito, Masaaki Ito (National Cancer Hospital East); Jou Tashiro (Saitama Medical University); Shigeki Yamaguchi (Saitama Medical University International Medical Center); Toshimasa Yatsuoka (Saitama Cancer Center); Tomohisa Furuhata, Kenji Okita (Sapporo Medical University); Yoshiro Kubo (Shikoku Cancer Center); Shuji Saito, Yosuke Kinugasa (Shizuoka Cancer Center); Hisanaga Horie (Jichi Medical University); Fumio Konishi (Saitama medical Center Jichi Medical University); Michitoshi Goto (Juntendo University); Junichi Tanaka, Shungo Endo (Showa University Northern Yokohama Hospital); Kohei Murata (Suita Municipal Hospital); Nobuyoshi Miyajima, Tadashi Suda, Tsukasa Shimamura (St. Marianna University); Yasuo Kawaguchi (Tuchiya General Hospital); Kenichi Sugihara (Tokyo Medical and Dental University Graduate School); Yoshihisa Saida, Toshiyuki Enomoto (Toho University Ohashi Medical Center); Takeshi Naito (Tohoku University); Yasuhiro Munakata, Souichi Tagami (Nagano Municipal Hospital); Satoshi Maruyama (Niigata Cancer Center Hospital); Takao Ichihara (Department of Surgery, Nishinomiya Municipal Central Hospital); Seiichiro Yamamoto (Hiratsuka City Hospital); Masazumi Okajima (Hiroshima City Hospital); Hitoshi Idani (Fukuyama Municipal Hospital); Yasuhiro Miyake (Minoh City Hospital); Shoichi Hazama (Yamaguchi University); and Kazuteru Watanabe (Yokohama City University Medical Center).

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Authors and Affiliations

  1. Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan

    Ryosuke Okamura, Koya Hida, Suguru Hasegawa & Yoshiharu Sakai

  2. Department of Surgery, Kochi Health Sciences Center, Kochi, Japan

    Madoka Hamada

  3. Department of Surgery, Osaka National Hospital, Osaka, Japan

    Masayoshi Yasui

  4. Department of Gastroenterological and Transplant Surgery, Hiroshima University Hospital, Hiroshima, Japan

    Takao Hinoi

  5. Department of Surgery, Kitasato University, Tokyo, Japan

    Masahiko Watanabe

Authors
  1. Ryosuke Okamura
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  2. Koya Hida
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  3. Suguru Hasegawa
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  4. Yoshiharu Sakai
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  5. Madoka Hamada
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  6. Masayoshi Yasui
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  7. Takao Hinoi
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  8. Masahiko Watanabe
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The Japan Society of Laparoscopic Colorectal Surgery

Corresponding author

Correspondence to Ryosuke Okamura.

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Okamura, R., Hida, K., Hasegawa, S. et al. Impact of intraoperative blood loss on morbidity and survival after radical surgery for colorectal cancer patients aged 80 years or older. Int J Colorectal Dis 31, 327–334 (2016). https://doi.org/10.1007/s00384-015-2405-5

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  • DOI: https://doi.org/10.1007/s00384-015-2405-5

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