Abstract
Introduction
The incidence of rectal cancer is highest in elderly patients. However, these patients
are often underrepresented in randomised studies. Therefore, it is not clear whether
results of rectal cancer studies are equally applicable to both elderly and younger
patients.
In this paper, the Dutch Total Mesorectal Excision (TME) study is revisited, focused
on patients aged 75 years and above. The rectal cancer databases of the Comprehensive
Cancer Centres (CCC) South and West were combined to analyse the effect of the TME-study
in three different periods: before (1990–1995), during (1996–1999) and after (2000–2002)
the trial.
Results
Implementation of preoperative radiotherapy, as investigated in the TME trial, and
the introduction of TME surgery resulted in improved 5 year survival during the subsequent
periods, in patients younger than 75 years, of 60% (1990–1995) to 67% (1996–1999)
and 70% (2000–2002) (log rank p < 0.0001). The older patients did not improve and remained at 41%, 40% and 43% at 5
years in the respective periods.
Furthermore, mortality during the first 6-month period after treatment is significantly
raised compared to younger patients: 14% in the elderly, compared to 3.9% in the younger
TME-study patient (p < 0.0001 X2). In the CCC database these figures were confirmed at 16% and 3.9% (p < 0.0001 X2).
Conclusion
Overall survival was not improved in the elderly rectal cancer patient after introduction
of preoperative radiotherapy and TME-surgery. Non-cancer related mortality is a significant
problem in the first 6 months after surgery.
Keywords
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Article info
Publication history
Published online: August 20, 2007
Accepted:
July 10,
2007
Received in revised form:
July 1,
2007
Received:
May 14,
2007
Identification
Copyright
© 2007 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
