What happens when we do not operate? Survival following conservative bowel cancer management

Abstract

Introduction While surgery is the cornerstone of bowel cancer treatment, it comes with significant risks. Among patients aged over 80 years, 30-day mortality is 13%-15%, and additionally 12% will not return home and go on to live in supportive care. The question for patients and clinicians is whether operative surgery benefits elderly, frail patients. Methods Multidisciplinary team outcomes between October 2010 and April 2012 were searched to conduct a retrospective analysis of patients with known localised colorectal cancer who did not undergo surgery due to being deemed unfit. Results Twenty six patients survived for more than a few weeks following surgery, of whom 20% survived for at least 36 months. The average life expectancy following diagnosis was 1 year and 176 days, with a mean age at diagnosis of 87 years (range 77-93 years). One patient survived for 3 years and 240 days after diagnosis. Conclusions Although surgeons are naturally focused on surgical outcomes, non-operative outcomes are equally as important for patients. Elderly, frail patients benefit less from surgery for bowel cancer and have higher risks than younger cohorts, and this needs to be carefully discussed when jointly making the decision whether or not to operate.

Management of patients with incurable colorectal cancer: a retrospective audit

“…The anatomical distribution of tumours in this study is consistent with the published literature. Our results demonstrated an almost even split between men and women [4,5].…”

“…Bethune et al . reported outcomes in 39 patients over the age of 80 with non‐metastatic colorectal cancer, excluded from surgical treatment owing to frailty . Nine patients died within 45 days of diagnosis, a further five at 36 months, with a mean survival of 1 year and 176 days compared to 178 days in our ≥ 80 cohort.…”

“…Whilst 30‐day mortality in patients over 80 receiving surgery is reportedly between 13% and 15%, 12% of this group are unable to return home postoperatively owing to increased care needs. Reaching the right decision for these patients to maximize quality of life is therefore essential .…”

Survival after non-resection of colorectal cancer: the argument for including non-operatives in consultant outcome reporting in the UK

“…The survival of this group of patients within our study was poor, with a two-year mortality rate of 76% and median survival of only 10.7 months post multidisciplinary team discussion. In a study by Bethune et al, 16 the multidisciplinary team cases of a single centre were reviewed to assess the outcome of patients aged over 80 years who did not undergo major resection. The average survival of the 29 patients was one year and 176 days.…”

Response to ‘Colorectal cancer resection in the Australian nonagenarian patient’

“…We do not know what would have happened to these patients had they not had an operation. Some research suggests that the mean life expectancy for non‐operative (due to lack of fitness) patients with non‐metastatic colorectal cancer is 1 year and 176 days; this group had a mean age of 87 years (range 77–93 years, n = 39) . So this study does not provide information on whether operating is the optimal patient management; however, we do also appreciate that 51.2% of emergency patients ( n = 62) would otherwise have died and the comments in this letter really only refer to elective patients.…”