Colorectal cancer in the elderly: characteristics and short term results

Abstract

Objective: to analyse the characteristics of colorectal cancer in elderly patients and to assess the outcomes of treatment.Materials and methods: the study included 1924 patients diagnosed with colorectal cancer during a 22 year period . We analysed patient clinical and demographic characteristics as well as their treatment and its outcome.Results: there was an increase in emergency surgery with age, increasing from 13% among patients under 80 years of age to 47% in those over 90 years of age (p = 0.0001). On the other hand, the overall percentage of patients who underwent surgical treatment decreased from 96% in patients younger than 80 years of age, to 85% and 59% in octogenarians and nonagenarians, respectively (p = 0.0001), and there was a similar pattern in the rates of curative surgery among patients who underwent surgery. The overall mortality of patients who underwent surgery was 8% (141 out of 1,769), increasing from 4% in patients younger than 70 years of age to 25% in those over 90 (p = 0.0001). Multivariate analysis showed that the factors associated with mortality were the emergency nature of the surgery (p = 0.001), the ASA grade (p = 0.0001), and the presence of systemic complications (p = 0.0001), the weight of age decreasing significantly with respect to the univariate analysis (p = 0.013).Conclusions: there is an increase in the rate of complicated forms of colorectal cancer with increasing age of patients. In addition, there is a dramatic decrease in the rate of curative tumour resection with increasing age. Intraoperative mortality for colorectal cancer in octogenarians and nonagenarians is more closely related to the nature and intent of the surgery (elective or emergency; palliative or curative), the perioperative risk (ASA grade), and severe systemic complications, than to age.

Emergency Major Abdominal Surgical Procedures in Older Adults: A Systematic Review of Mortality and Functional Outcomes

“…Table shows the reported mortality in older adults undergoing emergency major abdominal surgery, younger individuals emergency surgery, and older adults undergoing nonemergency surgery. For example, for emergency colonic operations, in‐hospital mortality ranged from 15% of individuals aged 65 and older at a single institution in the United States to 42% of individuals aged 90 and older at another in Spain . Reported 30‐day mortality ranged from 6% of individuals aged 65 to 79 at one Spanish hospital to 48% of nonagenarians in a national colon cancer database in Denmark .…”

“…Similarly, another study found that odds of death were more than three times as high after emergency major digestive tract surgery (OR = 3.4, 95% CI = 1.67–6.99) . Three additional studies did not report ORs for association between emergency surgery and mortality, but instead presented mortality rates of the emergency and elective cohorts . In all cases, the elective cohort had lower mortality (6%, 8%, and 6%) than their emergency counterparts (29%, 22%, and 21%, respectively).…”

“…Of the 20 studies, 14 included only individuals who underwent urgent or emergency surgery, whereas six included elective and urgent or emergency operations. 14,23,25,29,31,32 Definitions of emergency procedures included standardized definitions from prospectively collected databases (n = 7); [15][16][17][18][19]22,30 procedures occurring after nonelective hospital admissions (n = 5); 13,14,20,21,24 procedures occurring in the first 12, 24, or 72 hours after an unplanned admission (n = 2); 26,32 procedures for emergency pathology (n = 2); 27,28 procedures defined as emergency by the surgeon (n = 1); 31 and three studies that provided no specific definition for emergency procedures. 23,25,29 The types of surgeries also differed between studies.…”

“…14,23,25,29,31,32 Definitions of emergency procedures included standardized definitions from prospectively collected databases (n = 7); [15][16][17][18][19]22,30 procedures occurring after nonelective hospital admissions (n = 5); 13,14,20,21,24 procedures occurring in the first 12, 24, or 72 hours after an unplanned admission (n = 2); 26,32 procedures for emergency pathology (n = 2); 27,28 procedures defined as emergency by the surgeon (n = 1); 31 and three studies that provided no specific definition for emergency procedures. 23,25,29 The types of surgeries also differed between studies. Thirteen included only major colon surgeries, 13,14,16,[18][19][20][21][25][26][27][29][30][31] two included only laparotomies, 15,22 one included surgeries only for perforated peptic ulcers, 28 and the remaining five studies included some variation of major abdominal surgery on the upper digestive tract (n = 4), 15,17,23,…”

“…23,25,29 The types of surgeries also differed between studies. Thirteen included only major colon surgeries, 13,14,16,[18][19][20][21][25][26][27][29][30][31] two included only laparotomies, 15,22 one included surgeries only for perforated peptic ulcers, 28 and the remaining five studies included some variation of major abdominal surgery on the upper digestive tract (n = 4), 15,17,23,32 small bowel (n = 4), 15,17,24,32 biliary tract (n = 4), 17,23,24,32 pancreas (n = 2), 15,32 abdominal wall hernias (n = 1), 17 and large bowel (n = 5) 15,17,23,32 and exploratory laparotomies (n = 5). 15,17,[22][23][24] Eight of the studies reviewed included only older adults, which was defined according to numerous age cutoffs, including 80 and older (n = 5), 14,16,18,23,29 70 and older (n = 7), [20]…”