Safety of Colorectal Resections in Nonagenarians: A Systematic Review and Meta-Analysis

To evaluate feasibility and safety of colorectal cancer resection in nonagenarians.

In compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement standards, a systematic review including random-effects meta-analysis and meta-regression models was conducted. All studies reporting postoperative outcomes in patients aged ≥90 y undergoing colorectal resection for colorectal cancer were included and analyzed.

Eleven studies including 5276 nonagenarians were included. The risk of 30-d mortality was 4.5% (95% confidence interval [CI]: 1.8-7.3); 30-d Clavien-Dindo grade ≥ III complications occurred in 11.3% (95% CI: 2.1-20.6), and reoperation was needed in 2.2% (95% CI: 0.8-3.6). The mean length of hospital stay was 14.7 d (95% CI: 13.6-15.8). Colorectal resection in emergency setting (coefficient: 0.185, P < 0.001) and colorectal resection using open approach (coefficient: 0.119, P = 0.031) were associated with increased risk of 30-d mortality. Laparoscopic approach was associated with a lower risk of 30-d mortality (coefficient: -0.121, P = 0.024). Postoperative mortality was not affected by male sex (coefficient: -0.109, P = 0.548), American Society of Anesthesiologists status ≥ III (coefficient: 0.075, P = 0.371), colon resection (coefficient: -0.028, P = 0.740), or rectal resection (coefficient: 0.027, P = 0.747). Subgroup analyses showed that the risk of 30-d mortality was 2.5% (95% CI: 0.8-4.2%) after elective surgery and 18.8% (95% CI 1.7-36%) after emergency surgery.

The available evidence with low certainty suggests that colorectal cancer resection in highly selected nonagenarians with good performance status, who have passed robust preoperative fitness assessment tests, may be safe with acceptable risk of morbidity and mortality. The risk is significantly higher in emergency setting.