Outcome of Right Colectomy for Cancer in Octogenarians

  • Anne J. Gurevitch
  • Baruch Davidovitch
  • Hanoch Kashtan
original article



Colorectal cancer is one of the commonest malignancies in the elderly and, as such, is a major cause of morbidity and mortality. There is no consensus yet if age itself is a risk factor for adverse outcome after colectomy. The aims of the study were to evaluate the impact of age on operative results of right colectomy for cancer and to define factors that influence the postoperative mortality in octogenarians.


Data of all patients who underwent right colectomy for colon cancer between January 2001 and December 2006 were collected retrospectively. Patients were divided into two groups: those who were 80 years and older and those who were less than 80 years old. Analysis included patients’ demographics, comorbidities, American Society of Anesthesiologists class, functional status, mode of presentation, stage of disease, length of hospital stay, postoperative morbidity, and mortality.


A total of 124 consecutive patients with right colon cancer were operated. Control group included 84 patients less than 80 year old. Study group included 40 patients 80 years or older. In Cox multivariate regression analysis, poor functional status and emergent surgery were independent factors for postoperative mortality.


There was no significant difference in the outcome of elective right colectomy between elderly patients and their younger counterparts. Operative mortality of emergency surgery was significantly higher in octogenarians. Emergent setting and poor functional status are major risk factors for postoperative mortality.


Right colectomy Octogenarians Colorectal cancer Elderly Mortality 


  1. 1.
    Etzioni D, Liu J, Maggard M, Ko C. The aging population and its impact on the surgery workforce. Ann Surg 2003;238:170–177.PubMedGoogle Scholar
  2. 2.
    Parker SL, Tong T, Bolden S, Wingo PA. Cancer statistics. CA Cancer J Clin 1997;47:5–27. doi: 10.3322/canjclin.47.1.5.PubMedCrossRefGoogle Scholar
  3. 3.
    Chiappa A, Zbar AP, Bertani E, Biella F, Audisio RA, Staudacher C. Surgical outcomes for colorectal cancer patients including the elderly. Hepatogastroenterol 2001;48:440–444.Google Scholar
  4. 4.
    Kashtan H, Werbin N, Wasserman I, Stadler Y, Wiznitzer T. Colorectal cancer in patients over 70 years old. A prospective study of operative results. Isr J Med Sci 1992;28:861–864.PubMedGoogle Scholar
  5. 5.
    Irvin T. Prognosis of colorectal cancer in the elderly. Br J Surg 1988;75:419–421. doi: 10.1002/bjs.1800750508.PubMedCrossRefGoogle Scholar
  6. 6.
    Smith J, Lee J, Burke C, Dawson P. Major colorectal cancer resection should not be denied to the elderly. Eur J Surg Oncol 2002;28:661–666. doi: 10.1053/ejso.2002.1265.PubMedCrossRefGoogle Scholar
  7. 7.
    Obrand DI, Gordon PH. Continued change in the distribution of colorectal carcinoma. Br J Surg 1998;85:246–248. doi: 10.1046/j.1365-2168.1998.00507.x.PubMedCrossRefGoogle Scholar
  8. 8.
    Cheng X, Chen VW, Steele B, Ruiz B, Fulton J, Liu L, et al. Sub-site specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992–1997. Cancer 2001;92:2547–2554. doi: 10.1002/1097-0142(20011115)92:10<2547::AID-CNCR1606>3.0.CO;2-K.PubMedCrossRefGoogle Scholar
  9. 9.
    Dripps RD, Echenhoff JE, Vandom D. Introduction to anesthesia: the principles of safe practice. Philadelphia: WB Saunders Co, 1988, p 17.Google Scholar
  10. 10.
    Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: Reliability, validity, and guidelines. J Clin Oncol 1984;2:187–193.PubMedGoogle Scholar
  11. 11.
    Jemal A, Siegel R, Ward E, Hao A, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71–96.PubMedCrossRefGoogle Scholar
  12. 12.
    Ries L, Wingo PA, Miller DS, Howe HL, Weir HK, Rosenberg HM, et al. The annual report to the nation on the status of cancer 1973–1997 with a special section on colorectal cancer. Cancer. 2000;88:2398–2424. doi: 10.1002/(SICI)1097-0142(20000515)88:10<2398::AID-CNCR26>3.0.CO;2-I.PubMedCrossRefGoogle Scholar
  13. 13.
    Marusch F, Koch A, Schmidt U, et al. The impact of the risk factor “age” on the early postoperative results of surgery for colorectal carcinoma, and its significance for perioperative management. World J Surg 2005;29:1013–1022. doi: 10.1007/s00268-005-7711-6.PubMedCrossRefGoogle Scholar
  14. 14.
    Edna TH, Bjerkeset T. Colorectal cancer in patients over 80 years of age. Hepatogastroenterol 1998;45:2142–2145.Google Scholar
  15. 15.
    Damhuis RA, Wereldsma JC, Wiggers T. The influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer. Int J Colorectal Dis 1996;11:45–48.PubMedGoogle Scholar
  16. 16.
    Zhang B, Fattah A, Nakama H. Characteristics and survival rate of elderly patients with colorectal cancer detected by immunochemical occult blood screening. Hepatogastroenterol 2000;47:414–418.Google Scholar
  17. 17.
    Payne JE, Chapius PH, Pheilsy MT. Surgery for large bowel cancer in people aged 75 years and older. Dis Colon Rectum 1986;29:733–737. doi: 10.1007/BF02555321.PubMedCrossRefGoogle Scholar
  18. 18.
    Waldron R, Donovan I, Drumm J, Mottram S, Tedman S. Emergency presentation and mortality from colorectal cancer in the elderly. Br J Surg 1986;73:214–216. doi: 10.1002/bjs.1800730320.PubMedCrossRefGoogle Scholar
  19. 19.
    Edwards RT, Bransom CJ, Crosby DL, Pathy MS. Cotorectal carcinoma in the elderly: a geriatric and surgical practice compared. Age Ageing 1983;12:256–262. doi: 10.1093/ageing/12.3.256.PubMedCrossRefGoogle Scholar
  20. 20.
    Kemppainen M, Raiha I, Rajala T, Sourander L. Delay in diagnosis of colorectal cancer in elderly patients. Age Ageing 1993;22:260–264. doi: 10.1093/ageing/22.4.260.PubMedCrossRefGoogle Scholar
  21. 21.
    Wagner JL, Herdman RC, Wadhwa S. Cost effectiveness of colorectal cancer screening in the elderly. Ann Intern Med 1991;115(10):807–817.PubMedGoogle Scholar
  22. 22.
    Walsh J, Terdiman J. Colorectal cancer screening. JAMA 2003;289:1288–1296. doi: 10.1001/jama.289.10.1288.PubMedCrossRefGoogle Scholar
  23. 23.
    Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T. Emergency surgery for colon carcinoma. Dis Colon Rectum 2003;46:24–30. doi: 10.1007/s10350-004-6492-6.PubMedCrossRefGoogle Scholar
  24. 24.
    Biondo S, Marti-Rague J, Kreisler E, Pares D, Martin A, Navarro M, et al. Prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 2005;189:377–383. doi: 10.1016/j.amjsurg.2005.01.009.PubMedCrossRefGoogle Scholar
  25. 25.
    Jestin P, Nilsson J, Heurgren M, Pahlman L, Glimelius B, Gunnarsson U. Emergency surgery for colonic cancer in a defined population. Br J Surg 2005;92:94–100. doi: 10.1002/bjs.4780.PubMedCrossRefGoogle Scholar
  26. 26.
    Arnaud JP, Schloegel M, Ollier JC, Adloff M. Colorectal cancer in patients over 80 years of age. Dis Colon Rectum 1991;34:896–898. doi: 10.1007/BF02049704.PubMedCrossRefGoogle Scholar
  27. 27.
    Puig-La Calle J, Quayle J, Thaler HT, Shi W, Paty PB, Quan SH, et al. Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older. Dis Colon Rectum 2000;43:1704–1709. doi: 10.1007/BF02236854.PubMedCrossRefGoogle Scholar
  28. 28.
    Agarwal N, Leighton L, Mandile MA, Cayten CG. Outcomes of surgery for colorectal cancer in patients aged 80 years and older. Am J Gastroenterol 1990;85:1096–1101.PubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Anne J. Gurevitch
    • 1
    • 2
  • Baruch Davidovitch
    • 1
    • 2
  • Hanoch Kashtan
    • 1
    • 2
  1. 1.Department of Surgery BKaplan Medical CenterRehovotIsrael
  2. 2.Hebrew University School of MedicineJerusalemIsrael

Personalised recommendations