“Optimal recovery” after colon cancer surgery in the elderly, a comparative cohort study: Conventional care vs. enhanced recovery vs. prehabilitation / “Recuperación óptima” tras cirugía por cáncer de colon en el paciente añoso. Resultados de un estudio de cohorte: Cuidados convencionales, Recuperación intensificada y programa de prehabilitación

Background: Colon cancer in elderly patients is an increasing problem due to its prevalence and progressive aging population. Prehabilitation has experienced a great grown in this field. Whether it is the best standard of care for these patients has not been elucidated yet. Methods: A retrospective comparative cohort study of three different standards of care for elderly colon cancer patients (>65 years) was conducted. A four-weeks trimodal prehabilitation program (PP), enhanced recovery program (ERP) and conventional care (CC) were compared. Global complications, major complications (Clavien-Dindo ≥ 3), reinterventions, mortality, readmission and length of stay were measured. Optimal recovery, defined as postoperative course without major complications, no mortality, hospital discharge before the fifth postoperative day and without readmission, was the primary outcome measure. The influence of standard of care in optimal recovery and postoperative outcomes was assessed with univariate and multivariate logistic regression models. Results: A total of 153 patients were included, 51 in each group. Mean age was 77.9 years. ASA Score distribution was different between groups (ASA III-IV: CC 56.9%, ERP 25.5%, PP 58.9%; p = 0.014). Optimal recovery rate was 55.6% (PP 54.9%, ERP 66.7%, CC 45.1%; p = 0.09). No differences were found in major complications (p = 0.2) nor reinterventions (p = 0.7). Uneventful recovery favors ERP and PP groups (p = 0.046 and p = 0.049 respectively). Conclusions: PP and ERP are safe and effective for older colon cancer patients. Fewer overall complications and readmissions happened in ERP and PP patients. Major complications were independent of the standard of care used. (AU)

Introducción: El cáncer de colon (CC) en pacientes de edad avanzada es un problema creciente por su prevalencia y envejecimiento progresivo de la población. La prehabilitación ha experimentado un gran crecimiento en este campo sin haberse dilucidado si es el mejor estándar de cuidados para estos pacientes. Métodos: Estudio retrospectivo comparativo de cohortes de tres estándares diferentes de cuidados para pacientes mayores de 65 años con CC. Se compararon un programa de prehabilitación (PP) trimodal de cuatro semanas, uno de recuperación intensificada (RI) y cuidados convencionales (CC). Se midieron complicaciones globales, complicaciones mayores (Clavien-Dindo ≥ 3), reintervenciones, mortalidad, reingresos y estancia hospitalaria. La recuperación óptima fue la medida de resultado primaria. La influencia del estándar de atención en la recuperación óptima y los resultados postoperatorios se evaluó con modelos de regresión logística univariante y multivariante. Resultados: Se incluyeron 153 pacientes, 51 por grupo. La edad media fue 77,9 años. La distribución del ASA fue diferente entre los grupos (ASA III–IV: CC 56,9%, RI 25,5%, PP 58,9%; p = 0,014). La tasa de recuperación óptima fue del 55,6% (PP 54,9%, RI 66,7%, CC 45,1%; p = 0,09). No se encontraron diferencias en complicaciones mayores (p = 0,2) ni reintervenciones (p = 0,7). La recuperación sin incidencias favorece a los grupos RI y PP (p = 0,046 y p = 0,049 respectivamente). Conclusiones: PP y RI son seguros y efectivos para pacientes mayores con CC. Las complicaciones generales y reingresos en pacientes con RI y PP fueron menores. Las complicaciones mayores resultaron independientes del estándar de cuidados utilizado. (AU)

"Optimal recovery" after colon cancer surgery in the elderly, a comparative cohort study: Conventional care vs. enhanced recovery vs. prehabilitation.

BACKGROUND: Colon cancer in elderly patients is an increasing problem due to its prevalence and progressive aging population. Prehabilitation has experienced a great grown in this field. Whether it is the best standard of care for these patients has not been elucidated yet. METHODS: A retrospective comparative cohort study of three different standards of care for elderly colon cancer patients (>65 years) was conducted. A four-weeks trimodal prehabilitation program (PP), enhanced recovery program (ERP) and conventional care (CC) were compared. Global complications, major complications (Clavien-Dindo ≥ 3), reinterventions, mortality, readmission and length of stay were measured. Optimal recovery, defined as postoperative course without major complications, no mortality, hospital discharge before the fifth postoperative day and without readmission, was the primary outcome measure. The influence of standard of care in optimal recovery and postoperative outcomes was assessed with univariate and multivariate logistic regression models. RESULTS: A total of 153 patients were included, 51 in each group. Mean age was 77.9 years. ASA Score distribution was different between groups (ASA III-IV: CC 56.9%, ERP 25.5%, PP 58.9%; p = 0.014). Optimal recovery rate was 55.6% (PP 54.9%, ERP 66.7%, CC 45.1%; p = 0.09). No differences were found in major complications (p = 0.2) nor reinterventions (p = 0.7). Uneventful recovery favors ERP and PP groups (p = 0.046 and p = 0.049 respectively). CONCLUSIONS: PP and ERP are safe and effective for older colon cancer patients. Fewer overall complications and readmissions happened in ERP and PP patients. Major complications were independent of the standard of care used.