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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Gastroenterology 1/2014

Factors associated with mortality risk for malignant colonic obstruction in elderly patients

Zeitschrift:
BMC Gastroenterology > Ausgabe 1/2014
Autoren:
Ming-gao Guo, Yi Feng, Jia-zhe Liu, Qi Zheng, Jian-zhong Di, Yu Wang, You-ben Fan, Xin-Yu Huang
Wichtige Hinweise
Ming-gao Guo, Yi Feng contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MG: concept, design, data analysis, manuscript writing and editing. YF: concept, design, data analysis, manuscript writing. JL: concept, design, data analysis, manuscript writing and editing. QZ: concept, design, manuscript editing. JD: statistical analysis. YW: design of the study. YF: manuscript editing. XYH: concept, design. All authors read and approved the version to be published.

Abstract

Background

Acute colonic obstruction is the most common complication of colorectal cancer (CRC) in elderly patients. Medical treatment has been associated with higher perioperative morbidity and mortality rates. There is a need for identification of elderly CRC patients who will do poorly so that results can be improved. The purpose of this study is to assess the 30-day outcome of elderly patients undergoing malignant colonic obstruction procedures and identify the associated factors of mortality.

Methods

A review of 233 elderly patients who received medical procedures for malignant colonic obstruction between April 2000 and April 2012 was conducted. Data regarding clinical variables, surgical procedures and outcomes, complications, and mortality were studied. Univariate and logistic regression analyses were performed on mortality risk factors.

Results

Patients had a mean age of 78.2 years (range 70–95). A total of 126 (54.1%) patients were classified ASA III and above. Eighty (34.3%) patients had right-sided colonic obstruction. In the 153 (65.7%) patients with left-sided colonic obstruction, 40 patients received self-expandable metallic stent (SEMS) treatment and 193 patients received surgery. A total of 62.2% (n = 145) patients had post operation complications. The overall 30-day mortality was 24.5% (n = 57). ASA grading, peritonitis and Dukes staging were independent risk factors for mortality.

Conclusions

Medical procedures in elderly patients with malignant colonic obstruction are associated with significant complications and mortality. Identifying these high-risk patients and treating promptly may improve outcomes. SEMS treatment provides a useful alternative to surgical intervention.
Literatur
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