Minimally invasive compared to open colorectal cancer resection for older adults: a population-based analysis of long-term functional outcomes
Behman R, Chesney T, Coburn N, Haas B, Bubis L, Zuk V, Ashamalla S, Zhao H, Mahar A, Hallet J; REcovery after Surgical Therapy for Older adults Research – Cancer (RESTORE-Cancer). Ann Surg. 2021; Aug 19 [Epub ahead of print]. DOI: https://doi.org/10.1097/SLA.0000000000005151
Objective — We sought to compare long-term healthcare dependency and time-at-home between older adults undergoing minimally invasive surgery (MIS) for colorectal cancer (CRC) and those undergoing open resection.
Background — Although the benefits of MIS for CRC resection are established, data specific to older adults are lacking. Long-term functional outcomes, central to decision-making in the care for older adults, are unknown.
Methods — We performed a population-based analysis of patients ≥70 years old undergoing CRC resection between 2007 to 2017 using administrative datasets. Outcomes were receipt of homecare and "high" time-at-home, which we defined as years with ≤14 institution-days, in the 5 years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High time-at-home was assessed using Cox multivariable models.
Results — Of 16,479 included patients with median follow-up of 4.3 (interquartile range 2.1-7.1) years, 7822 had MIS (47.5%). The MIS group had lower homecare use than the open group with 22.3% versus 31.6% at 6 months and 14.8% versus 19.4% at 1 year [hazard ratio 0.87, 95% confidence interval (CI) 0.83-0.92]. The MIS group had higher probability of high time-at-home than open surgery with 54.9% (95% CI 53.6%-56.1%) versus 41.2% (95% CI 40.1%-42.3%) at 5 years (hazard ratio 0.71, 95% CI 0.68-0.75).
Conclusions — Compared to open surgery, MIS for CRC resection was associated with lower homecare needs and higher probability of high time-at-home in the 5 years after surgery, indicating reduced long-term functional dependence. These are important patient-centered endpoints reflecting the overall long-term treatment burden to be taken into consideration in decision-making.