The prognosis of patients with colorectal cancer (CRC) of different onset ages is controversial.
Data were obtained from a prospective database at Taipei Veterans General Hospital. There were 2,738 newly diagnosed patients with CRC from 2001 to 2006. Two extreme age groups, younger (≤40 years) and elderly (≥80 years), were analyzed to compare clinicopathologic characteristics and prognosis after exclusion of specific cancer syndrome.
A total of 322 patients were enrolled in this prospective study. The younger group consisted of 69 patients with mean age of 33.5 years, and the elderly group consisted of 253 patients with mean age of 83.4 years. Younger patients had a higher incidence of mucinous cell type (14.5% vs 6.3%, P = .05), poorly differentiated adenocarcinoma (26.1% vs 6.3%, P < .001), more advanced disease (82.6% vs 41.9%, P < .001), poorer disease-free survival (67.2% vs 79.3%, P = .048), and cancer-specific survival (44.1% vs 73.1%, P < .001) than elderly patients.
In patients with CRC of younger onset, without relevant predisposing risk factors, younger patients have more advanced stages of disease, more aggressive histopathologic characteristics, and poorer prognoses compared with older patients.
"Contradictory to our results, the proportion of patients undergoing emergency surgery was described more than twice as high in the 85 years and above group than in the less than 65 years group . Survival of emergency cases has been shown to be poorer than in those who undergo elective surgery as a result of a higher perioperative mortality rate after emergency surgery (p < 0.001 for our cohort, data not shown) [3, 10, 13]. Differences between studies may be explained, at least in part, by the considerably lower number of patients in our analysis. "
[Show abstract][Hide abstract] ABSTRACT: Background
The incidence of colorectal cancer rises disproportionally in aging persons. With a shift towards higher population age in general, an increasing number of older patients require adequate treatment. This study aims to investigate differences between young and elderly patients who undergo resection for colorectal cancer, regarding clinical characteristics, morbidity, and prognosis.
By retrospective analysis of 6 years (2007 to 2012) of a prospectively documented database, a total of 636 patients were identified who underwent oncological resection for colorectal cancer at our institution. Of this total, all 569 patients with primary colorectal adenocarcinoma were included. Four hundred ten patients were 74 years or younger and 159 were 75 years or older. The median follow-up was 22 months.
Older patients had significantly more comorbidities (85 % vs. 56 %, p < 0.001) and a higher ASA score (p < 0.001). The mean length of stay in the hospital was longer (24 vs. 20 days, p = 0.002), as was the length of postoperative intensive care stay (4 vs. 2 days, p = 0.003). However, elderly patients did not have significantly higher rates of intraoperative complications or surgical morbidity. Tumor-specific 2-year survival was 83 ± 4 % for the elderly and 87 ± 2 % for the younger patients, which was not significantly different (p = 0.90).
Long-term outcome after oncologic resection for colorectal cancer does not differ between elderly and younger patients. Age in general should not be considered as a limiting factor for colorectal cancer surgery or tumor-specific prognosis.
International Journal of Colorectal Disease 06/2014; 29(8). DOI:10.1007/s00384-014-1914-y · 2.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Endoscopic submucosal dissection (ESD) has recently been applied to treatment of colorectal neoplasia; however, its safety and efficacy in terms of follow-up outcomes in elders have not been thoroughly examined. The aim of this study is to describe the clinical outcomes of colorectal ESD in elderly patients.
Two groups of patients, elderly (≥75 years of age) and non-elderly (<75 years of age), who underwent colorectal ESD at the National Cancer Center Hospital from February 1998 to December 2010 were retrospectively compared on the following measures: tumor size, procedure time, complication rates, en bloc resection rates, and curative resection rates. We also investigated the follow-up outcomes in non-curative resection cases.
Of 614 consecutive patients treated by colorectal ESD, 125 (20.4 %) comprised the elderly group, and 489 patients (79.6 %) comprised the non-elderly group. No significant differences were observed between the two groups in terms of tumor size, procedure time, complication rates, en bloc resection rates, and curative resection rates. Of the patients who underwent non-curative resection, 7/19 (36.8 %) and 47/63 (74.6 %) in the elderly and non-elderly group, respectively, underwent additional treatment. Among the elderly patients who were followed up without additional treatment, no case of local recurrence, residual lesions, or distant metastases was observed during the observation period.
Treatment outcomes of colorectal ESD were equivalent in both groups. However, many of the non-curative cases in the elderly patients were followed up without additional treatment. Future studies should focus on the outcome in such patients to confirm the feasibility of colorectal ESD in elderly patients.
International Journal of Colorectal Disease 06/2012; 27(11):1493-9. DOI:10.1007/s00384-012-1514-7 · 2.45 Impact Factor
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