Our experience in surgery for colorectal cancer in elderly patients

Background

The effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives. Since colorectal cancer is a major cause of morbidity and mortality in elderly people [1], this study was designed to evaluate the outcomes of surgery in elderly patients.

Materials and methods

In the period 1973-2003, in our institution, we surgically managed 931 patients for colorectal cancer; 48 patients, 28 males and 20 females, aged 80 years and over (mean age 83.7 years). The tumor was located in the left colon in 20 cases (41.6%), in the rectum in 11 (22.9%) and in the right colon in 17 patients (35.4%). 33 patients (68.7%) were treated with colonic resection and primary anastomosis, 8 (16.6%) with Hartmann resection, 5 (10.4%) with colostomy, 1 (2%) with abdominal perineal resection and 1 (2%) with anastomosis between ileum and transverse colon without resection. The stage was A in 7 patients, B in 22, C in12 and D in 7.

Results

The operative mortality rate was 0. The infection of the surgical wound occurred in 10 patients, whereas 4 cases of bronchopneumonia took place (8.3%). We had also registered 1 anastomotic leak in a male patient with left colon cancer (2.08%). The median hospital stay was 13.1 days (range 9-22 days) and the 5 year survival was 56.2% (27/48). No patients had adjuvant therapy

Conclusions

This study demonstrates that surgery should not be denied to elderly patients with colorectal cancer; age is not a limitation for surgery, tumour stage and co-morbidity define the surgical treatment [2]. The morbidity and mortality figures for elective procedures are not different from the younger age population and favourable long-term outcome can be achieved by resectional surgery [3]. Diagnostic methods, rate of curative operations performed, staging, morbidity rate and 5-year survival rate are similar to younger patients. Finally the behaviour of colorectal carcinoma does not change with age and the age has no effect on the long-term survival of elderly patients.