Radikale Resektion des kolorektalen Karzinoms bei Hochbetagten

Abstract

Radical resection can be safely performed even at an advanced age. Since age-corrected survival is comparable to that of younger patients, surgery should be performed in the elderly under elective conditions according to oncological criteria.

Colorectal cancer surgery remains effective with rising patient age

“…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 [10]. 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.…”

“…As found in our study, higher rates of comorbidities and higher ASA scores required a longer hospital stay for elderly patients for the preoperative assessment and postoperative surveillance, as well as longer postsurgical intensive care monitoring. However, an increased number of general complications in elderly patients may also have led to a prolonged hospital and ICU stay [3, 10]. …”

“…With a rise from 5 to 14 %, the percentage of people over 80 years is estimated to be more than doubled in 2050 in Western countries [1–3]. Aging may alter the body’s antitumor defenses, making older persons more vulnerable to malignancies [4, 5].…”

“…In fact however, patients aged 75 years have a mean of five comorbidities at the time colorectal cancer is diagnosed [1]. The most relevant comorbidities for surgery are cardiovascular and pulmonary diseases, tumor anemia, and liver or kidney disorders, which are common in elderly patients [1–3]. Furthermore, neurological or psychological disorders and polypharmacy are often prevalent in aged patients [2].…”

“…Thus, the indication for colorectal cancer surgery in the elderly is a matter of debate [10]. The question remains whether those patients profit or may even be harmed by extensive surgery [3]. Most prospective clinical trials do not enroll older persons.…”