Abstract
Objective
To evaluate the epidemiology and risk of surgery in the treatment of colorectal cancer
in the elderly.
Methods
Patients undergoing colorectal cancer surgery were identified from the Association
of Coloproctology of Great Britain and Ireland (ACPGBI) bowel cancer database, comprising
47,455 patients treated over a 5-year period. Demographic characteristics and outcomes
were compared between patients aged <75 and those 75 or above. The primary endpoint
was 30-day mortality. Secondary endpoints were the length of hospital stay, abdominoperineal
excision (APER) rates and lymph node harvest.
Results
Elderly patients were likely to be female and have higher American Society of Anaesthesiology
(ASA) grade, while Dukes’ stage was lower. They underwent surgery less often (81%
versus 88%, p < 0.001), but more frequently needed urgent or emergency procedures (p < 0.001) and non-excisional surgery (7.7% versus 6.6%, p < 0.001). Operative mortality was significantly higher for the older age group (10.6%
versus 3.8%, p < 0.001), and their median length-of-stay was 2 days longer (p < 0.001). Mortality has improved over time for elderly patients with ASA grade III,
and Dukes’ stage A and D disease, but not for other subgroups.
Conclusion
Significant differences in the demographic characteristics and operative risk-factors
between under-75s, and those aged 75 or above exist. These variations are reflected
in the inferior outcomes experienced by elderly patients.
Keywords
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References
Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer incidence, mortality and prevalence worldwide, version 2.0. IARC Cancer Base No. 5 Lyon, IARC Press; 2004.
America Cancer Society: Cancer Facts & Figures. Surveil Res 2003;5008.03:20–6.
- Prevention of colorectal cancer by once-only sigmoidoscopy.Lancet. 1993; 341: 736-740
- Prognosis of elderly patients with large bowel cancer.Br J Surg. 1994; 81: 736-738
- Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older.Dis Colon Rectum. 2000; 43: 1704-1709
- Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study.Eur J Cancer. 2006; 42: 3015-3021
- Assessment of operative risk in colorectal cancer surgery: the Cleveland Clinic Foundation colorectal cancer model.Dis Colon Rectum. 2004; 47: 2015-2024
- Prediction of postoperative mortality in elderly patients with colorectal cancer.Dis Colon Rectum. 2006; 49: 816-824
- Which comorbid conditions predict complications after surgery for colorectal cancer?.World J Surg. 2007; 31: 192-199
- Alternative clinical end points in rectal cancer – are we getting closer?.Ann Oncol. 2006; 17: 1239-1248
- Quality of life in colorectal cancer. Stoma vs. nonstoma patients.Dis Colon Rectum. 1995; 38: 361-369
- Quality of life in rectal cancer patients: a four-year prospective study.Ann Surg. 2003; 238: 203-213
- Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer.Ann Surg. 2001; 233: 149-156
- Functional and quality-of-life outcomes in patients with rectal cancer after combined modality therapy, intraoperative radiation therapy, and sphincter preservation.Dis Colon Rectum. 2000; 43: 752-758
- Quality of life in survivors of colorectal carcinoma.Cancer. 2000; 88: 1294-1303
- Quality of life among disease-free survivors of rectal cancer.J Clin Oncol. 2004; 22: 354-360
- Operative mortality in colorectal cancer: prospective national study.BMJ. 2003; 327: 1196-1201
The Association of Coloproctology of Great Britain and Ireland Database and Dataset. In. Version 2 for Access 2000 UK edition: Clin IT; 2000. p. 2000.
- The role of anesthesia in surgical mortality.JAMA. 1961; 178: 261-266
- Cancer of the colon: the influence of the no-touch isolation technique on survival rates.Ann Surg. 1967; 166: 420-427
Callum K, Gray A, Hoile R, et al. Appendix A. In: Then and now: the 2000 report of the national confidential enquiry into perioperative deaths. London: NCEPOD; 2000. p. 2000.
- Abdominoperineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer.World J Surg. 1997; 21: 715-720
- Local recurrence following total mesorectal excision for rectal cancer.Br J Surg. 1996; 83: 375-379
- Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM).Br J Surg. 2004; 91: 1174-1182
- Are survival rates different for young and older patients with rectal cancer?.Dis Colon Rectum. 2004; 47: 2064-2069
- Lifestyle and 30-day complications to surgery for colorectal cancer.Acta Oncol. 2005; 44: 218-223
- Surgery for colorectal cancer in elderly patients.Acta Chir Scand. 1988; 154: 659-663
- Comparison of colonic stenting and open surgery for malignant large bowel obstruction.Surg Endosc. 2007; 21: 225-233
- Surgery and pre-operative irradiation for locally advanced or recurrent rectal cancer in patients over 75 years of age.Colorectal Dis. 2006; 8: 177-185
- Patients’ expectations of colorectal surgery for cancer.Colorectal Dis. 2006; 8: 186-191
- Colorectal carcinoma – aspects of surgery in the elderly.Anticancer Res. 1997; 17: 1273-1276
- Emergency surgery for colon cancer in the aged.Arch Surg. 1997; 132: 1032-1037
- Prognosis of colorectal cancer in the elderly.Br J Surg. 1988; 75: 419-421
- Colorectal cancer in patients over 75 years of age – determinants of outcome.Eur J Surg Oncol. 1997; 23: 13-19
- Rectal cancer treatment of the elderly.Colorectal Dis. 2006; 8: 471-479
- Cancer treatment and age: patient perspectives.J Natl Cancer Inst. 1993; 85: 1580-1584
- Curative surgery for colorectal cancer: long-term results and life expectancy in the elderly.Dis Colon Rectum. 1998; 41: 291-298
- Survival after operations for colorectal cancer in patients aged 75 years or over.Eur J Surg. 2000; 166: 473-479
- Surgical outcomes for colorectal cancer patients including the elderly.Hepatogastroenterology. 2001; 48: 440-444
- Complications and survival after surgery for rectal cancer in patients younger than and aged 75 years or older.Dis Colon Rectum. 2004; 47: 1225-1231
- Surgery for large bowel cancer in people aged 75 years and older.Dis Colon Rectum. 1986; 29: 733-737
- Outcomes of surgery for mid and distal rectal cancer in the elderly.World J Surg. 2006; 30: 598-604
- Colorectal cancer in patients over 80 years of age.Dis Colon Rectum. 1991; 34: 896-898
- The management of rectal cancer in the elderly.Surg Oncol. 2004; 13: 223-234
- Colorectal surgery in octogenarians.J Am Coll Surg. 1996; 183: 46-50
- Survival of colorectal carcinoma in the elderly. A prospective study of colorectal carcinoma and a five-year follow-up.Dis Colon Rectum. 1997; 40: 523-529
- A pilot study of factors influencing bowel function after colorectal anastomosis.Dis Colon Rectum. 1996; 39: 744-749
- Pre-operative short-course radiotherapy is associated with faecal incontinence after anterior resection.Colorectal Dis. 2003; 5: 563-568
- Serial evaluation of anorectal function following low anterior resection of the rectum.Int J Colorectal Dis. 1998; 13: 241-246
- Causes of rectal incontinence after sphincter-preserving operations for rectal cancer.Dis Colon Rectum. 1996; 39: 1423-1427
- Continence after colorectal reconstruction following resection: impact of level of anastomosis.Int J Colorectal Dis. 1997; 12: 82-87
- Level of the anastomosis does not influence functional outcome after anterior rectal resection for rectal cancer.Am J Surg. 1995; 169 ([discussion 152–153]): 147-152
- Effect of anterior resection on anal sphincter function.Br J Surg. 1989; 76: 783-786
- Colorectal cancer in patients over 70 years old. A prospective study of operative results.Isr J Med Sci. 1992; 28: 861-864
- Age-associated prognosis following curative resection for colorectal cancer.Tech Coloproctol. 2004; 8: s144-s146
Article info
Publication history
Published online: August 03, 2007
Accepted:
June 20,
2007
Received in revised form:
June 13,
2007
Received:
May 8,
2007
Identification
Copyright
© 2007 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
