• Ramy Behman, Tyler Chesney, Natalie Coburn, Barbara Haas, Lev Bubis, Victoria Zuk, Shady Ashamalla, Haoyu Zhao, Alyson Mahar, Julie Hallet, and REcovery after Surgical Therapy for Older adults Research – Cancer (RESTORE-Cancer) group.
• Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
• Ann. Surg. 2023 Feb 1; 277 (2): 291298291-298.

ObjectiveWe 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.BackgroundAlthough 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.MethodsWe performed a population-based analysis of patients ≥70years 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 5years after surgery. Homecare was analyzed using time-to-event analyses as a recurrent dichotomous outcome with Andersen-Gill multivariable models. High timeat-home was assessed using Cox multivariable models.ResultsOf 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 ofhigh 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 5years (hazard ratio 0.71, 95% CI 0.68-0.75).ConclusionsCompared 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.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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