Perioperative and oncologic outcomes in young and octogenarian patients with colorectal cancer: a comparison at the extremes

Chan, Dedrick Kok Hong; Leong, Sze Wai; Keh, Christopher Hang Liang

doi:10.1007/s00423-021-02275-w

Cited by 7 publications

(4 citation statements)

References 31 publications

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“…In an ageing population, the cohort of patients being treated for colorectal cancer is evolving, and previous uncertainty regarding survival outcomes in octogenarians may lead to hesitancy in offering standard treatment. 15 Within any population, the risk-benefit ratio of administering chemotherapy needs to be considered no less so amongst octogenarians, who naturally will have a higher rate of all-cause mortality than their younger counterparts. Decisions regarding chemotherapy administration ought to consider the risk-benefit ratio on an individual level.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite providing a clear improvement in cancer‐specific survival, octogenarians were far less likely to be administered adjuvant chemotherapy. In an ageing population, the cohort of patients being treated for colorectal cancer is evolving, and previous uncertainty regarding survival outcomes in octogenarians may lead to hesitancy in offering standard treatment 15 …”

Section: Discussionmentioning

confidence: 99%

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Adjuvant chemotherapy improves survival amongst octogenarians following resection of colorectal adenocarcinoma

Fernando,

Hanna,

Cohen

et al. 2023

ANZ Journal of Surgery

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BackgroundThe Australian population is ageing, with an increasing number of patients diagnosed with colorectal cancer in their eighth decade. This group represents a challenging cohort to deliver multidisciplinary care, with increased morbidity and mortality related to surgical and oncological therapies. This project aimed to compare surgical and oncological outcomes in octogenarian and non‐octogenarian patients with colorectal cancer.MethodsA matched case–control retrospective review of a prospectively maintained institutional database of colorectal cancer patients treated between 2005 and 2021 was conducted. Patient demographics, treatment details, peri‐operative complications, and long‐term survival were reported. The primary outcome, cancer‐specific survival, was investigated using time‐to‐event analysis and interrogated with multivariate regression.ResultsThere were 747 patients included in the study. There was no difference in five‐year cancer‐specific survival and recurrence‐free survival between cohorts. Multivariate analysis for octogenarians confirmed a significant hazard signal associated with worsening cancer stage and a survival benefit associated with the administration of adjuvant therapy. However, we noted that stage‐matched octogenarian patients received less adjuvant treatment compared to non‐octogenarians.ConclusionOctogenarians undergoing treatment for colorectal cancer have similar cancer‐specific survival and recurrence‐free survival to non‐octogenarians. Our study demonstrates a survival benefit when adjuvant therapy is provided to octogenarians, despite only half of this cohort receiving therapy compared to their younger peers. Further research into adjuvant therapy with surgical resection for CRC in older Australians is required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy improves survival amongst octogenarians following resection of colorectal adenocarcinoma

Fernando,

Hanna,

Cohen

et al. 2023

ANZ Journal of Surgery

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“…Although surgical site infection and anastomotic leaks were not more frequent in older patients, associated mortality was increased [ 25 ]. Others have also observed that when compared with colorectal cancer patients younger than 50 years old, octogenarians undergoing surgery for colorectal cancer had no increased rates of re-intervention and no differences in the Clavien–Dindo classification of post-operative complications [ 26 ]. However, given the increased mortality once complications have occurred, surgical treatment of colorectal cancer in octogenarians and older patients should be discussed with patients and their families in an individualized manner.…”

Section: Treatments Of Colorectal Cancers In Octogenarians and Older ...mentioning

confidence: 99%

Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old

Voutsadakis

2023

Medicina

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Background: An increasing proportion of the population of patients with cancer presents at an advanced age, increasing the challenges of successful and well-tolerated treatments. In the older spectrum of the geriatric cancer patients, those older than 80 years old, challenges are even higher because of increasing comorbidities and decreasing organ function reserves. Methods: Studies regarding colorectal cancer presentation, treatment, and prognosis in patients older than 80 years old available in the literature were evaluated and were compiled within a narrative review. Molecular attributes of colorectal cancer in the subset of patients older than 80 years old in published genomic cohorts were also reviewed and were compared with similar attributes in younger patients. Results: Characteristics of colorectal cancer in octogenarians are in many aspects similar to younger patients, but patients older than 80 years old present more often with right colon cancers. Surgical treatment of colorectal cancer in selected patients over 80 years old is feasible and should be pursued. Adjuvant chemotherapy is under-utilized in this population. Although combination chemotherapy is in most cases not advisable, monotherapy with fluoropyrimidine derivatives is feasible and efficacious. Conclusions: Outcomes of colorectal cancer patients over the age of 80 years old may be optimized with a combination of standard treatments adjusted to the individual patient’s functional status and organ reserves. Increased support for the older age group during their colorectal cancer treatment modalities would improve oncologic outcomes with decreasing adverse outcomes of therapies.

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“…With the development in surgical technique and management, curative resection in elderly cancer patients aged C 80 years has been demonstrated to achieve acceptable postoperative morbidity and long-term survival rates. 1,2 However, the feasibility of palliative surgery in this population has rarely been discussed because of its palliative nature. Through our clinical experience in Japan, one of the most long-lived countries, a concern arose that extreme old age might negatively impact shortterm outcomes after gastrojejunostomy (GJ) for malignant gastric outlet obstruction (mGOO).…”

Section: Pastmentioning

confidence: 99%

ASO Author Reflections: Palliative Surgery for Very Elderly Cancer Patients Does Not Guarantee Surgical Safety

Yao

Kita

2022

Ann Surg Oncol

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Perioperative and oncologic outcomes in young and octogenarian patients with colorectal cancer: a comparison at the extremes

Cited by 7 publications

References 31 publications

Adjuvant chemotherapy improves survival amongst octogenarians following resection of colorectal adenocarcinoma

Adjuvant chemotherapy improves survival amongst octogenarians following resection of colorectal adenocarcinoma

Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old

ASO Author Reflections: Palliative Surgery for Very Elderly Cancer Patients Does Not Guarantee Surgical Safety

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