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Adjudication committee
- First opponent: Consultant Surgeon Anandi Schiphorst, Department of Colorectal Surgery, Diakonessenhuis, Utrecht, The Netherlands
- Second opponent: Professor Else Marie Skjøde Damsgaard, Department of Clinical Medicine, Aarhus University, Denmark
- Third member and chair of the evaluation committee: Professor Emeritus Stein Olav Kvaløy, Faculty of Medicine, University of Oslo
Chair of the Defence
Associate Professor Morten Mowe, Faculty of Medicine, University of Oslo
Principal Supervisor
Associate Professor Siri Rostoft, Faculty of Medicine, University of Oslo
Summary
Older patients with colorectal cancer (CRC) often have coexisting health issues, such as comorbidities, polypharmacy, malnutrition or reduced physical and cognitive function. However, the degree to which such age-related health issues are present varies considerably between individuals. This can be expressed as the patient’s level of frailty. Frail older patients have higher risk for postoperative complications. Geriatric Assessment (GA) with interventions is a method to measure frailty status and optimize health and function of each patient.
Our main aim was to investigate through a randomized controlled trial whether performing a preoperative GA with interventions could reduce the occurrence of complications after surgery for CRC in frail older patients. We also examined the role of frailty in predicting one- and five year survival after surgery.
Postoperative complications were frequent. In total, 95 frail patients (82%) experienced a postoperative complication; 75% in the group that went through a preoperative GA with interventions and 87% in the control group. Most complications were low-grade, and medical complications were more frequent than surgical complications. Twenty percent of patients were discharged from hospital without complications, but developed complications after discharge. Patients who had complications in hospital had significantly longer length of stay, were more often discharged to an institution, and had poorer five-year survival.
One year after surgery, 87% of patients were alive, significantly fewer in the frail group (80%) than the non-frail group (92%). Five years after surgery 24% of frail patients and 66% of non-frail patients were alive.
Overall, frailty predicted both one-year and five-year survival. The effects of GA with interventions in reducing postoperative complications are still not clear. A potential effect may be seen in reducing the minor complications and the medical, as opposed to surgical, morbidity.
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