Insights Into the Group of Surgically Resectable but Nonoperable Patients with Colorectal Cancer.

Abstract

Background: The incidence of colorectal cancer is expected to increase, particularly among patients with significant frailty and comorbidities. A subgroup of these patients may not be suitable for surgery due to the high risk of postoperative morbidity and mortality.

Objective: The aim of this study was to characterize the clinical outcomes, management, social status, and survival of patients deemed nonoperable due to comorbidity and/or frailty.

Design: This was a retrospective cohort study.

Settings: Overall survival was estimated using the Kaplan-Meier method. Cox proportional-hazards model was used to estimate hazard ratios and 95% confidence intervals for mortality associated modifiable risk factors.

Patients: Patients diagnosed with resectable colorectal cancer but deemed nonoperable due to comorbidity and/or frailty by a multidisciplinary team between January 1, 2020, and April 30, 2024, were included in this study.

Main outcome measures: The primary outcome was to describe the current population, investigate mortality, and explore mortality-related risk factors in the current population.

Results: During the study period, 69 out of 1667 patients were potentially resectable but were deemed nonoperable and included in the study population. The rate of 90-days and 1-year mortality was 20% and 52%, respectively. Three-years after the diagnosis 12% of the patients were alive. At the time of diagnosis, anemia was found in 73% of female patients and 71% of male patients. Additionally, 77% of the patients had hypoalbuminemia. Lower albumin levels were associated with poor survival, hazard ratio of 0.92 (95% confidence interval: 0.88-0.98, p = 0.007).

Limitations: The retrospective nature and small sample size inherently limit the generalizability of the study's findings.

Conclusions: Mortality in the current population was high. However, our findings highlight potential areas for improvements in the management of these patients. See Video Abstract.