Can elderly patients with colorectal cancer tolerate planned  surgical treatment? A practical approach to a common dilemma.
OBJECTIVE
Analysing the effectiveness of a surgical procedure is mandatory in every modern health-care system. The aging of the population stresses the need for a good standard of care. This study tests the hypothesis that porthsmouth-physiologic operative severity score for enumeration of morbidity and mortality (P-POSSUM) and colorectal-POSSUM (CR-POSSUM) would be useful clinical auditing tools in colorectal cancer surgery for aged patients.


METHODS
One hundred and seventy-seven consecutive patients over 70 years of age underwent emergency or elective surgery from January 2003 to December 2005. Demographic, clinical and surgical information, score systems' prediction, complications and 30-day mortality data were prospectively entered in a comprehensive database. The observed over expected morbidity and mortality rate was calculated.


RESULTS
Thirty-day observed mortality was 10.3% (19/177) while P-POSSUM and CR-POSSUM expected mortality were, respectively, 11.21% (P = NS) and 13.08% (P = NS). Overall observed morbidity was 42.7%, P-POSSUM prediction was 59.3% (P = 0.002). Morbidity and mortality data were analysed for specific subgroups of patients (resection and anastomosis/resection and stoma/palliative; emergency/elective).


CONCLUSIONS
P-POSSUM and CR-POSSUM are useful tools to predict mortality in elderly patients. P-POSSUM significantly overestimated the risk of complications. A more accurate tool for preoperative assessment for aged patients is probably needed to predict the post-surgical outcome.
Ugolini
G
G
Department of General Surgery, Emergency Surgery and Organ Transplantation, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. ugolini.g@aosp.bo.it
Rosati
G
G
Montroni
I
I
Zanotti
S
S
Manaresi
A
A
Giampaolo
L
L
Blume
J Friederike
JF
Taffurelli
M
M
D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality*; D003110:Colonic Neoplasms / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D018579:Patient Selection; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index