J Korean Surg Soc.  2010 Feb;78(2):93-99. 10.4174/jkss.2010.78.2.93.

The Outcome and Propriety of Surgical Treatment of Colorectal Cancer in the Elderly

• Hwang HW
• Koo MY
• Lee JE
• Lee RA
• Kim KH

• KMID: 2096561
• DOI: http://doi.org/10.4174/jkss.2010.78.2.93

Abstract

PURPOSE
As life expectancy increases, elderly colorectal cancer patients are also increasing. Compared to younger patients, the elderly manifest higher co-morbidity with more advanced and emergent disease. However, recent studies have reported similar surgical approaches irrespective of age distribution. We evaluated the outcome and propriety of surgical treatment of colorectal cancer in the elderly.
METHODS
The medial records of 464 colorectal patients, who underwent surgery during 2003 to 2007 in Ewha Womans University Mokdong Hospital were reviewed retrospectively. The patients were divided into three groups according to age: I (younger than 70), II (71~80), III (older than 81). Clinical and histological characteristics, surgical outcomes and survival rates were analyzed.
RESULTS
Three hundred and thirty-eight patients belonged to group I, and 104 patients to group II, and group III included 22 patients. Although, male patients were more prevalent in all three groups, female distribution was slightly higher in group III. Clinical characteristics among the three groups did not reveal specific differences except TNM stage distribution. In group I and II, patients with stage II were more common compared to group III, whereas the latter showed most frequently stage III. Histological characteristics and postoperative morbidity rates did not show any difference among the three groups. The survival rate was lowest in group III. However, emergency operation was more frequent in group III, in accordance with increased postoperative complications.
CONCLUSION
The elderly demonstrated comparable operative morbidity and mortality to the younger patients. Emergency operation was the only significantly influencing factor in the surgical outcome. Therefore, in colorectal cancer patients, surgical treatment in the elderly should be no longer contraindicated.

Keyword

Old-age; Colorectal cancer; Surgical treatment

MeSH Terms

Age Distribution
Aged
Colorectal Neoplasms
Emergencies
Female
Humans
Life Expectancy
Male
Retrospective Studies
Survival Rate

Figure

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  Fig. 1 Complication rate according to age (P<0.05). This figure shows that the Group 3 had the highest complication rate.

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  Fig. 2 Emergency operation rate according to age (P=0.079). The tendency of the proportion of emergency operation increased in the older group was illustrated in this figure. There is no statistical difference between groups.

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  Fig. 3 Postoperative complication rate (P<0.05). The postoperative complication rate of emergency operation is higher than the elective one in all studied patients.

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  Fig. 4 Survival curves according to age. This figure shows that Group 3 had the lowest 5-year survival rate.

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  Fig. 5 Survival curves according to curative resection in Group 3 (P<0.05). Survivals in the patients undergoing curative resection were longer than palliative resection.

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  Fig. 6 Survival curves according to chemotherapy in Group 3 (P=0.067). The survival rate of chemotherapy is higher than in the others.

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