PURPOSE:
An increasing number of rectal cancer patients are elderly and have comorbid medical diseases. This study was designed to compare perioperative morbidity, mortality, and survival after surgery for rectal cancer in patients younger than and aged 75 years or older.
METHODS:
Between 1980 and 1997, 294 patients with rectal cancer were admitted to the Fourth Department of Surgery, Helsinki University Central Hospital. Of these, 95 (32 percent) were aged 75 or older and comprise the elderly group.
RESULTS:
Major curative operation was possible in 59 of 95 patients in the elderly group and in 147 of 199 patients in the younger age group. Among those operated on with curative intent, 20 of 59 patients (34 percent) in the older age group and 39 of 147 patients (27 percent) in the younger age group had complications (P = 0.31). Thirty-day mortality was 2 percent (n = 1) and 0, respectively. Although five-year crude survival was significantly lower in the older age group (43 vs. 65 percent, P = 0.01), five-year cancer-specific survival (60 vs.70 percent, P = 0.6) and disease-free, five-year survival (60 vs. 69 percent, P = 0.4) were similar in both groups. Patients (n = 17) treated with local excision had a cancer-specific survival of 81 and 83 percent in younger and older age groups, respectively. After palliative resection, the two-year survival was similar (20 vs. 24 percent) in both age groups. Ten elderly patients (11 percent) were not operated on at all in contrast to two patients (1 percent) younger than aged 75 years (P = 0.003).
CONCLUSIONS:
Major, curative, rectal cancer surgery in selected elderly patients can be performed with similar indications, perioperative morbidity, and mortality, as well as five-year, cancer-specific and disease-free survival as in younger patients.
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REFERENCES
A Shankar I Taylor (1998) ArticleTitleTreatment of colorectal cancer in patients aged over 75 Eur J Surg Oncol 24 391–5
O Hessman L Bergkvist S Ström (1997) ArticleTitleColorectal cancer in patients over 75 years of age: determinants of outcome Eur J Surg Oncol 23 13–9
HE Mulcahy SE Patchett L Daly DP Odonoghue (1994) ArticleTitlePrognosis of elderly patients with large bowel cancer Br J Surg 81 736–8
A Chiappa AP Zbar E Bertani F Biella RA Audisio C Staudacher (2001) ArticleTitleSurgical outcomes for colorectal cancer patients including the elderly Hepatogastroenterology 48 440–4
J Puig-La Calle J Quayle HT Thaler et al. (2000) ArticleTitleFavorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older Dis Colon Rectum 43 1704–9
J Mäkelä H Kiviniemi S Laitinen (2000) ArticleTitleSurvival after operations for colorectal cancer in patients aged 75 years or over Eur J Surg 166 473–9
JJ Arenal C Benito MP Concejo E Ortega (1999) ArticleTitleColorectal resection and primary anastomosis in patients aged 70 and older: prospective study Eur J Surg 165 593–7
V Violi N Pietra M Grattarola et al. (1998) ArticleTitleCurative surgery for colorectal cancer: long term results and life expectancy in the elderly Dis Colon Rectum 41 291–8
RD Kingston J Jeacock S Walsh F Keeling (1995) ArticleTitleThe outcome of surgery for colorectal cancer in the elderly: a 12-year review from the Trafford Database Eur J Surg Oncol 21 514–6
JP Arnaud M Schloegel JC Ollier M Adloff (1991) ArticleTitleColorectal cancer in patients over 80 years of age Dis Colon Rectum 34 896–8
RA Damhuis JC Wereldsma T Wiggers (1996) ArticleTitleThe influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer Int J Colorect Dis 11 45–8
RJ Heald EM Husband RD Ryall (1982) ArticleTitleThe mesorectum in rectal cancer surgery: the clue to pelvic recurrence? Br J Surg 69 613–6
JH Anderson D Hole CS McArdle (1992) ArticleTitleElective versus emergency surgery for patients with colorectal cancer Br J Surg 79 706–9
LP Fielding RK Phillips R Hittinger (1989) ArticleTitleFactors influencing mortality after curative resection for large bowel cancer in elderly patients Lancet 1 595–7
R Bleday (1997) ArticleTitleLocal excision of rectal cancer World J Surg 21 706–4
S Ranta M Hynynen T Tammisto (1997) ArticleTitleA survey of the ASA physical status classification: significant variation in allocation among Finnish anaesthesiologists Acta Anaesth Scand 41 629–32
SR Haynes PG Lawler (1995) ArticleTitleAn assessment of the consistency of ASA physical status classification allocation Anaesthesia 50 195–9
InstitutionalAuthorNameFinnish Cancer Registry (2003) ArticleTitleCancer statistics. Available at: www.cancerregistry.fi Updated August 13
S Delgado AM Lacy JC Valdecasas et al. (2000) ArticleTitleCould age be an indication for laparoscopic colectomy in colorectal cancer? Surg Endosc 14 22–6
P Reissman F Agachan S Wexner (1996) ArticleTitleOutcome of laparoscopic colorectal surgery in older patients Am Surg 62 1060–3
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Vironen, J., Sainio, P., Husa, A. et al. Complications and Survival After Surgery for Rectal Cancer in Patients Younger Than and Aged 75 Years or Older. Dis Colon Rectum 47, 1225–1231 (2004). https://doi.org/10.1007/s10350-004-0557-4
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DOI: https://doi.org/10.1007/s10350-004-0557-4