Authors
Maksimenkov A.V., Troshina A.A., Botov A.V., Stoyko Y.M.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Colorectal cancer (CRC) is one of the most common types of cancer worldwide. It ranks 3rd in the structure of the total oncological incidence and in the vast majority of cases is detected in people ≥65 years of age. Patients of this age are often found to have several chronic diseases that aggravate the outcomes of surgical treatment of CRC. The aim of this study was to identify the main comorbid diseases that significantly affect the outcome of surgical treatment of patients with CRC with the determination of the specifics of the management tactics for these categories of patients. The conducted system analysis showed that the frequency of detection of comorbid diseases in patients with CRC is 28.0% (4053/14473). The most common comorbidities are diseases of the gastrointestinal tract — 55% (279/505 patients), diabetes mellitus — 50% (1923/3825 patients), cardiovascular diseases — 42% (1469/3519 patients). The incidence of postoperative non-surgical complications in patients with CRC and comorbid pathology is 33% (53/162 patients), and postoperative mortality is 13% (31/242 patients). The most frequently identified cardiac complications (42% — 47/162 patients). Among comorbid diseases, a special role is given to coronary heart disease, severe cardiac arrhythmias, chronic obstructive pulmonary disease and diabetes mellitus. An analysis of scientific papers has shown that the presence of comorbid pathology including in geriatric patients is not a contraindication to surgical intervention for CRC. However, this category of patients in the perioperative period needs a differentiated and personalized approach regarding the benefits and risks of the necessary medical interventions.
Keywords: сolorectal cancer, comorbidity, multimorbidity, polymorbidity, prognosis.
References
1. Chong RC, Ong MW, Tan KY. Managing elderly with colorectal cancer. J Gastrointest Oncol. 2019; 10(6): 1266-1273. doi: 10.21037/jgo.2019.09.04.
2. Kaprin AD, Starinskii VV, Shakhzadova AO Zlokachestvennye novoobrazovaniya v Rossii v 2020 godu (zabolevaemost’ i smertnost’). M.: MNIOI im. P.A. Gertsena − filial FGBU «NMITs radiologii» Minzdrava Rossii. 2021. (In Russ.)
3. Podda M, Sylla P, Baiocchi G, et al. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project. World J Emerg Surg. 2021; 16(1): 35. doi: 10.1186/ s13017-021-00378-9.
4. Hahn EE, Gould MK, Munoz-Plaza CE, et al. Understanding Comorbidity Profiles and Their Effect on Treatment and Survival in Patients With Colorectal Cancer. J Natl Compr Canc Netw. 2018; 16(1): 23-34. doi: 10.6004/jnccn.2017.7026.
5. Montroni I, Ugolini G, Saur NM, et al. Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer. Eur J Surg Oncol. 2018; 44(11): 1685-1702. doi: 10.1016/j.ejso.2018.08.003.
6. Pule ML, Buckley E, Niyonsenga T, Roder D. The effects of comorbidity on colorectal cancer mortality in an Australian cancer population. Sci Rep. 2019; 9(1): 8580. doi: 10.1038/s41598-019-44969-8.
7. Cummings A, Grimmett C, Calman L, et al. Comorbidities are associated with poorer quality of life and functioning and worse symptoms in the 5 years following colorectal cancer surgery: Results from the ColoREctal Well-being (CREW) cohort study. Psychooncology. 2018; 27(10): 2427-2435. doi: 10.1002/pon.4845.
8. Nguyen H, Manolova G, Daskalopoulou C, et al. Prevalence of multimorbidity in community settings: A systematic review and meta-analysis of observational studies. J Comorb. 2019; 9: 2235042X19870934. doi: 10.1177/2235042X19870934.
9. Oganov RG, Simanenkov VI, Bakulin IG, et al. Comorbidities in clinical practice. Algorithms for diagnostics and treatment. Cardiovascular Therapy and Prevention. 2019; 18(1): 5-66. (In Russ). doi: 10.15829/1728-8800-2019-1-5-66.
10. Nekoval VM, Efetov SK, Tsarkov PV. Geriatric approach to the treatment of senile patients with colorectal cancer. Medical Council. 2021; 21(2): 72-79. (In Russ.) doi: 10.21518/2079-701X-2021-21-2-72-79.
11. Drapkina OM, Kontsevaya AV, Kalinina AM, et al. Prevention of chronic non-communicable diseases in the Russian Federation. National guidelines. Cardiovascular Therapy and Prevention. 2022; 21(4): 3235. (In Russ.) doi: 10.15829/1728-8800-2022-3235.
12. Oganov RG, Denisov IN, Simanenkov VI, et al. Comorbidities in practice. Clinical guidelines. Cardiovascular Therapy and Prevention. 2017; 16(6): 5-56. (In Russ.) doi: 10.15829/1728-8800-2017-6-5-56.
13. Samorodskaya IV, Nikiforova MA. Terminology and methods of assessment of influence of comorbidity on prognosis and outcomes of treatment. Bjulleten’ NCSSH im. AN Bakuleva RAMN Serdechno-sosudistye zabolevanija. 2013; 14(4): 18-26. (In Russ.)
14. Artamonov RG. K voprosu o komorbidnosti v pediatricheskoi praktike. Pediatriya. Zhurnal im. GN Speranskogo. 2012; 91(4): 146-149. (In Russ.)
15. Kokenova ZK. Definitions in medicine — language of science. Vestnik Kazakhskogo Natsional’nogo meditsinskogo universiteta. 2013; 3(2): 366-368. (In Russ.)
16. Drapkina OM, Shutov AM, Efremova EV. Comorbidity, multimorbidity, dual diagnosis — synonyms or different terms? Cardiovascular Therapy and Prevention. 2019; 18(2): 65-69. (In Russ.) doi: 10.15829/ 1728-8800-2019-2-65-69.
17. Lazebnik LB, Konev YuV. Historical features and semantic difficulties of using the terms denoting multiplicity of diseases in one patient. Experimental and Clinical Gastroenterology. 2018; 154(6): 4-9. (In Russ.)
18. Kudesia P, Salimarouny B, Stanley M, et al. The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review. J Multimorb Comorb. 2021; 11: 21. doi: 10.1177/26335565211032880.
19. Kingston A, Robinson L, Booth H, et al. MODEM project. Projections of multi-morbidity in the older population in England to 2035: estimates from the Population Ageing and Care Simulation (PACSim) model. Age Ageing. 2018; 47(3): 374-380. doi: 10.1093/ageing/afx201.
20. Zabozlaev FG, Zairatyants OV, Kakturskii LV, et al. Methodological recommendations for the final comparison of the clinical and pathological / forensic diagnoses. Russian Journal of Forensic Medicine. 2019; 5(4): 48-56. (In Russ.) doi: 10.19048/2411-8729-2019-5-4-48-56.
21. Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020; 25(1): 1-42. doi: 10.1007/s10147-019-01485-z.
22. Pavelets KV, Lobanov MYu, Shishlikova YuS, et al. Mul’tidistsiplinarnyi podkhod v khirurgicheskom lechenii kolorektal’nogo raka u bol’nykh pozhilogo i starcheskogo vozrasta s vysokim operatsionno-anesteziologicheskim riskom. Sovremennye problemy nauki i obrazovaniya. 2018; 5. (In Russ.)
23. Klinicheskie rekomendatsii «Zlokachestvennye novoobrazovaniya obodochnoi kishki i rektosigmoidnogo otdela». Utverzhdeny Nauchno-prakticheskim Sovetom Minzdrava RF v 2020 g. (In Russ.)
24. Cuthbert CA, Hemmelgarn BR, Xu Y, Cheung WY. The effect of comorbidities on outcomes in colorectal cancer survivors: a population-based cohort study. J Cancer Surviv. 2018; 12(6): 733-743. doi:10.1007/s11764-018-0710-z.
25. Holden CA, Poprawski D, Singhal N, et al. A systematic scoping review of determinants of multidisciplinary cancer team access and decision-making in the management of older patients diagnosed with colorectal cancer. J Geriatr Oncol. 2020; 11(6): 909-916. doi:10.1016/j.jgo.2019.11.002.
26. Kellokumpu I, Kairaluoma M, Mecklin JP, et al. Impact of Age and Comorbidity on Multimodal Management and Survival from Colorectal Cancer: A Population-Based Study. J Clin Med. 2021; 10(8): 1751. doi:10.3390/jcm10081751.
27. Tsar’kov PV, Nikoda VV, Stamov VI, et al. The efficacy of the multidisciplinary approach in colorectal cancer surgery in elderly patients. Pirogov Russian Journal of Surgery. 2012; (2): 4‑13. (In Russ.)
28. Rapovka VG, Gavrina SE, Ponomarev AF, et al. Methods of improving results of scheduled surgery on colorectal cancer in patients at old age. Pacific Medical Journal. 2012; 4: 39-42. (In Russ.)
29. Khrykov GN, Maistrenko NA. Ogranichivaet li vozrast ob”em khirurgicheskogo vmeshatel’stva pri kolorektal’nom rake. Prakticheskaya onkologiya. 2015; 16(3): 95-103. (In Russ.)
30. Markar’yan DR, Nikoda VV, Tsar’kov PV. Mul’tidistsiplinarnyi podkhod v perioperatsionnom vedenii bol’nykh kolorektal’nym rakom v starcheskom vozraste. Rossiiskii zhurnal gastroenterologii, gepatologii, koloproktologii. 2011; 21(1): 50-56. (In Russ.)
31. Fukuoka A, Makizumi R, Asano T, Hamabe T, Otsubo T. Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients. J Anus Rectum Colon. 2021; 5(3): 247-253. doi:10.23922/jarc.2020-095.
32. Luque-Fernandez MA, Gonçalves K, Salamanca-Fernández E, et al. Multimorbidity and short-term overall mortality among colorectal cancer patients in Spain: A population-based cohort study. Eur J Cancer. 2020; 129: 4-14. doi:10.1016/j.ejca.2020.01.021.
33. Zhou S, Zhou H, Zheng Z, et al. Predictive risk factors for anastomotic leakage after anterior resection of rectal cancer in elderly patients over 80 years old: an analysis of 288 consecutive patients. World J Surg Oncol. 2019; 17(1): 112. doi:10.1186/s12957-019-1655-z.
34. Ryadinskaya LA, Pashchenko DG. Komorbidnye zabolevaniya pri kolorektal’nom rake. Sibirskii onkologicheskii zhurnal. 2010; 1: 87. (In Russ.)
35. Luque-Fernandez MA, Redondo-Sanchez D, Lee SF, et al. Multimorbidity by Patient and Tumor Factors and Time-to-Surgery Among Colorectal Cancer Patients in Spain: A Population-Based Study. Clin Epidemiol. 2020; 12: 31-40. doi:10.2147/CLEP.S229935.
36. ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management. Russian Journal of Cardiology. 2015; 8: 7-66. (In Russ.) doi: 10.15829/1560-4071-2015-8-7-66.
37. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. Linee guida ESC/EACTS 2018 sulla rivascolarizzazione miocardica. Task Force sulla Rivascolarizzazione Miocardica della Società Europea di Cardiologia (ESC) e dell’Associazione Europea di Chirurgia Cardiotoracica (EACTS) [2018 ESC/EACTS Guidelines on myocardial revascularization. The Task Force on myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS)]. G Ital Cardiol (Rome). 2019; 20(7-8.Suppl 1): 1S-61S. doi:10.1714/3203.31801.
38. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018; 39(3): 213-260. doi:10.1093/eurheartj/ehx419.
39. Kolesnikov VE, Burcev DV. Influence of comorbide pathology on the efficiency of laparoscopic operations in surgical treatment of patients with metastatic colorectal cancer. Medical Herald of the South of Russia. 2018; 9(4): 49-56 (In Russ.) doi: 10.21886/2219-8075-2018-9-4-49-56.
40. Gevorkyan YuA, Kolesnikov VE, Soldatkina NV, et al. Minimally invasive surgery in treatment of patients with metastatic colorectal cancer. South Russian Journal of Cancer. 2020; 1(2): 22-27. (In Russ.) doi: 10.37748/2687-0533-2020-1-2-3.
41. Puzanov DP, Polovinkin VV, Puzanova IA. Colorectal cancer screening. Current techniques and recommendations review. Innovatsionnaya meditsina Kubani. 2018; 1(9): 58-64. (In Russ.)
42. Yusupova NZ, Giniyatullina LA. Analysis current understanding of the role of various risk factors in the development of colorectal cancer (literature review). Vestnik novykh meditsinskikh tekhnologii. 2020; 27(4): 5-10. (In Russ.)
43. Devoto L, Celentano V, Cohen R, Khan J, Chand M. Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. Int J Colorectal Dis. 2017; 32(9): 1237-1242. doi:10.1007/s00384-017-2848-y.
44. Zhou S, Wang X, Zhao C, et al. Laparoscopic vs open colorectal cancer surgery in elderly patients: short- and long-term outcomes and predictors for overall and disease-free survival. BMC Surg. 2019; 19(1): 137. doi:10.1186/s12893-019-0596-3.
45. Fizulin MM, Pavlenko SG. Povyshenie effektivnosti lecheniya bol’nykh kolorektal’nym rakom starshikh vozrastnykh grupp. Sovremennye problemy nauki i obrazovaniya. 2020; 3. (In Russ.) doi:10.17513/spno.29797.
46. Boakye D, Walter V, Jansen L, et al. Magnitude of the Age-Advancement Effect of Comorbidities in Colorectal Cancer Prognosis. J Natl Compr Canc Netw. 2020; 18(1): 59-68. doi:10.6004/jnccn.2019.7346.
47. Flynn DE, Mao D, Yerkovich ST, et al. The impact of comorbidities on post-operative complications following colorectal cancer surgery. PLoS One. 2020; 15(12): e0243995. doi:10.1371/journal.pone.0243995.
48. Sarsenbayeva GI, Tursynbekova AE. Modern approaches to the assessment of comorbidity in patients. Cardiosomatics. 2019; 10(1): 19-23. (In Russ.) doi: 10.26442/22217185.2018.4.180073.
49. Wu CC, Hsu TW, Chang CM, Yu CH, Lee CC. Age-adjusted Charlson comorbidity index scores as predictor of survival in colorectal cancer patients who underwent surgical resection and chemoradiation. Medicine (Baltimore). 2015; 94(2): e431. doi:10.1097/MD.0000000000000431.
50. Tian Y, Jian Z, Xu B, Liu H. Age-adjusted Charlson comorbidity index score as predictor of survival of patients with digestive system cancer who have undergone surgical resection. Oncotarget. 2017; 8(45): 79453-79461. doi:10.18632/oncotarget.18401.
51. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5): 373-383. doi: 10.1016/0021-9681(87)90171-8.
52. Boakye D, Rillmann B, Walter V, Jansen L, Hoffmeister M, Brenner H. Impact of comorbidity and frailty on prognosis in colorectal cancer patients: A systematic review and meta-analysis. Cancer Treat Rev. 2018; 64: 30-39. doi:10.1016/j.ctrv.2018.02.003.
53. Quintana JM, Antón-Ladislao A, González N, et al. Predictors of one and two years’ mortality in patients with colon cancer: A prospective cohort study. PLoS One. 2018; 13(6): e0199894. doi:10.1371/journal.pone.0199894.
54. Tan KY, Konishi F, Tan L, et al. Optimizing the management of elderly colorectal surgery patients. Surg Today. 2010; 40(11): 999-1010. doi:10.1007/s00595-010-4354-5.
55. Xue DD, Cheng Y, Wu M, Zhang Y. Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: a meta-analysis. Clin Interv Aging. 2018; 13: 723-736. doi:10.2147/CIA.S155409.
