Diagnostic Interval for Oldest-Old Patients with II–III Stage Right Colon Cancer

Abstract

Introduction: the lack of comprehensive screening programs for colorectal cancer detection in oldest-old steadily leads to an increase in the diagnostic interval (DI), i.e. the time from the patient’s first presentation of complaints until diagnosis and treatment. At the same time, worsening the general somatic condition and developing the decompensation of concomitant diseases. Thus, patients with long-term DI need additional measures while preparing for surgery; the preoperative bed-day increases.Purpose of the study: to evaluate the impact of the diagnostic interval on the short-term results of II and III stages right colon cancer treatment in geriatric patients.Materials and methods: a retrospective multicenter study was conducted at the surgical facilities of Sechenov University from 2006 to 2015. The study included patients aged over 75 who have undergone surgical treatment of II and III stages right colon cancer. The control group comprised patients with CRC diagnosis in the period from 0 to 6 months; the studied group involved patients with a diagnostic interval over than 6 months.Results and conclusions. Analysis of the results revealed that patients older than 80 years had a longer diagnostic interval, which is statistically significant (p<0.001). Prolongation of the diagnostic interval for more than 6 months has shown a decrement in the polymorbidity indicators and operational and anesthetic risk compared with DI≤6 months (p=0.001, p=0.039). Polymorbidity, in particular cardiovascular diseases decompensation, affected the indicators of operational and anesthetic risk on the ASA scale, which were significantly higher in the study group (p=0.039). High level of polymorbidity required a longer preoperative preparation in the studied group, which is statistically significant in comparison with the control group (p=0.018). Statistically significant differences in early postoperative complications rate in both groups were not revealed. 30 and 90 day mortality rates were similar in the studied and control groups (p=0.225, p=0.353). The study has also shown that diagnostic interval (DI) have no effect on the prevalence of II and III stages comparing with the control group (p=0.315).