Prognosis of non-operative management of non-metastatic colorectal cancer in octa- and nonagenarians

Abstract

Introduction The aim of the study was to establish the natural history of elderly patients with non-metastatic colorectal cancer who underwent non-operative management in comparison with those who underwent operative management. Materials and methods A retrospective analysis of patients aged 80 years and above diagnosed with colorectal cancer between 2007 and 2015 in a tertiary care hospital in the Southwest of England was done. Patients were divided into non-operatively managed and operatively managed groups. Clinical demographics, Charlson Comorbidity Index, location of the tumour and overall survival between the two groups were compared. Results A total of 407 patients were studied; 132 were treated non-operatively and 275 operatively. The non-operative group included fewer right-sided colon cancers (28.7% vs 54.9%), but significantly more rectal cancers were managed non-operatively (43.9 vs 23.6%, respectively). The two and five year overall survival was 38.9% and 11.3% respectively in the non-operative group, significantly lower than patients in the operative group where the two and five year survival was 78.9% and 59.6% respectively (p = .0001). The median Charlson Comorbidity Index was 7.99 for the non-operative group and 7.49 in the operative group (p = 0.109). Patients treated non-operatively were deemed unfit without objective frailty assessment and only 43/132(32.6%) had formal anaesthetic assessment before being deemed unfit for surgery. Conclusion The survival of octa- and nonagenarians with non-metastatic colorectal cancer managed conservatively is significantly less than counterparts managed operatively. Our present strategy of deciding and denying treatment of the elderly patient with colorectal cancer is arbitrary, highlighting the need for robust geriatric and frailty assessment.

Frailty and Colorectal Surgery: Review and Concept of Cancer Frailty

“…In total, 132 patients did not undergo surgical resection. The 2-and 5-year overall survival rates in the non-surgical group were 38.9% and 11.3%, respectively, which were significantly lower than those in the surgical group [46]. The authors also noted that only one-third of these patients underwent a formal anesthetic assessment concerning fitness/unfitness for surgery.…”

“…In such cases, the survival rate with non-surgical treatment tends to be poor. Thus, the interpretations of the referenced studies [44][45][46][47][48][49][50] require caution and should not be misused to guide patients and families to undergo surgery (Table 1). A large study of 20,423 patients aged >70 years with colorectal cancer was conducted in the Netherlands [45].…”