title: Impact of intraoperative blood loss on morbidity and survival after radical surgery for colorectal cancer patients aged 80 years or older.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  The degree of IBL is significantly associated with postoperative morbidity and survival in very elderly colorectal cancer patients.
authors.affiliation: Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan. rokamura@kuhp.kyoto-u.ac.jp.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Okamura
authors.affiliation: Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Koya
authors.initials: K
authors.lastname: Hida
authors.affiliation: Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Hasegawa
authors.affiliation: Department of Surgery, Kyoto University Hospital, 54 Shogoin-Kawara-Cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
authors.affiliation: Department of Surgery, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Madoka
authors.initials: M
authors.lastname: Hamada
authors.affiliation: Department of Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Yasui
authors.affiliation: Department of Gastroenterological and Transplant Surgery, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Hinoi
authors.affiliation: Department of Surgery, Kitasato University, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 80 years or older; Blood loss; Colorectal cancer; Elderly