Surgical treatment of colorectal cancer in patients aged over 80 years

Institute of Clinical Medicine, Department of Surgery, Oulu University Hospital, PO Box 22, 90029 OYS Oulu, Finland.
International Journal of Colorectal Disease (Impact Factor: 2.45). 02/2012; 27(8):1055-60. DOI: 10.1007/s00384-012-1427-5
Source: PubMed


The aim of this study was to identify the clinical factors and tumour characteristics that predict the outcome in patients older than 80 years with colorectal cancer.
One hundred and four patients with colorectal cancer aged over 80 years were identified from a computer database, and their clinical variables were analysed by both univariate and multivariate analyses.
All 104 patients underwent resective surgery, 87% radical and 13% palliative resection. Postoperative mortality was 5%, being associated with a number of coexisting diseases and the presence of postoperative complications, especially anastomotic leakage. The cumulative 5-year survival was 33%, the median survival was 31 months and the cancer-specific 5-year survival was 36%. The recurrence rate after radical surgery was 30%, being 13%, 25%, 44% and 100% in the Union for International Cancer Control stages I, II, III and IV. Kaplan-Meier estimates indicated that age, number of underlying diseases, radicality of operation, Dukes' staging, size of tumour, number of lymph node metastasis, metastasised disease, venous invasion and recurrent disease were significant predictors of survival, but in the Cox regression model, only venous invasion was an independent prognostic factor of survival.
Low mortality and acceptable survival can be achieved even in very elderly patients with colorectal cancer. Venous invasion is an independent predictor of survival.

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    ABSTRACT: More than half of colorectal cancers occur in patients older than 75 years. This group is not homogeneous but variably vulnerable to disease, diagnostics, treatment procedures and complications. This review highlights the age-specific aspects of diagnostics and screening, curative and adjuvant treatment and the prognostic and predictive value of a geriatric assessment. A survey was carried out based on a selection of the relevant literature. The number of publications is currently rapidly increasing and even now it becomes apparent that a geriatric assessment carried out by the primary physician, can better predict therapy-linked adverse events and allow for a more individualized assessment of indications for diagnostics and screening of surgical and medicinal treatment. In particular this applies to total mesorectal resection and to the adjuvant use of oxaliplatin. Even in the older age group screening colonoscopy and surgical and medicinal adjuvant treatment can be reasonably used when aligned to the results of a carefully performed geriatric assessment. A severely reduced life-expectancy (generally with more than 2 comorbidities) should lead to more conservative approaches.
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