Highlights
- •Differences in mortality between older and younger CRC patients decreased.
- •One-year relative survival became nearly equal for older and younger patients.
- •Previous literature is no longer representative of the current clinical practice.
Abstract
Aim of the study
Previous studies have shown that older patients benefited less than younger patients
from surgical treatment for colorectal cancer (CRC). However, CRC care has advanced
over time, and it is time to assess whether the difference in postoperative mortality
between older and younger CRC patients is still present.
Methods
Patients with primary stage I-III CRC diagnosed between 2005 and 2016 were selected
from the Netherlands Cancer Registry (N = 111,778). Trends in postoperative mortality
and 1-year postoperative relative survival (RS) were analysed, stratified according
to age (<75 versus ≥75 years) and tumour location (colon versus rectum). One-year
postoperative RS was analysed to correct for background mortality in the older population.
Results
Between 2005 and 2016, 30-day postoperative mortality showed a stronger decrease for
older patients (from 10.0% to 4.0% for colon cancer [p < 0.001] and from 8.3% to 2.7%
for rectal cancer [p < 0.001]) compared with younger patients (from 2.0% to 0.9% for
colon cancer [p < 0.001] and from 1.4% to 0.7% for rectal cancer [p = 0.01]). Between
2005 and 2016, also 1-year RS increased more for older patients (from 84.8% to 94.6%
for colon cancer and from 86.1% to 97.2% for rectal cancer) compared with younger
patients (from 94.0% to 97.8% for colon cancer and from 96.3% to 98.8% for rectal
cancer).
Conclusion
Between 2005 and 2016, differences in postoperative mortality between older and younger
CRC patients decreased. One-year postoperative RS was almost equal for older and younger
patients in 2015–2016. This information is crucial for shared decision-making on surgical
treatment.
Keywords
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Article info
Publication history
Published online: June 01, 2019
Accepted:
April 27,
2019
Received in revised form:
April 22,
2019
Received:
March 10,
2019
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
