Abstract
Purpose
The aim of this study was to identify the clinical factors and tumour characteristics that predict the outcome in patients older than 80 years with colorectal cancer.
Patients and methods
One hundred and four patients with colorectal cancer aged over 80 years were identified from a computer database, and their clinical variables were analysed by both univariate and multivariate analyses.
Results
All 104 patients underwent resective surgery, 87% radical and 13% palliative resection. Postoperative mortality was 5%, being associated with a number of coexisting diseases and the presence of postoperative complications, especially anastomotic leakage. The cumulative 5-year survival was 33%, the median survival was 31 months and the cancer-specific 5-year survival was 36%. The recurrence rate after radical surgery was 30%, being 13%, 25%, 44% and 100% in the Union for International Cancer Control stages I, II, III and IV. Kaplan–Meier estimates indicated that age, number of underlying diseases, radicality of operation, Dukes’ staging, size of tumour, number of lymph node metastasis, metastasised disease, venous invasion and recurrent disease were significant predictors of survival, but in the Cox regression model, only venous invasion was an independent prognostic factor of survival.
Conclusions
Low mortality and acceptable survival can be achieved even in very elderly patients with colorectal cancer. Venous invasion is an independent predictor of survival.
Similar content being viewed by others
References
Sunouchi K, Namiki K, Mori M, Shimazu T, Radokoro M (2000) How should patients 80 years of age or older with colorectal cancer be treated? Long-term and short-term outcome and postoperative cytokine levels. Dis Colon Rectum 43:233–241
Ferley J, Shun HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127:2893–2917
Atkin WS, Cuzick J, Northover JM, Whynes DK (1993) Prevention of colorectal cancer by once-only sigmoidoscopy. Lancet 341:736–740
Lang K, Korn JR, Lee DW, Lines LM, Earle CC, Menzin J (2009) Factors associated with improved survival among older colorectal cancer patients in the US: a population-based analysis. BMC Cancer 9:220–227
Parkin MD, Whelan SL, Ferlay J, Teppo L, Thomas DB (eds) (2002) Cancer incidence in five continents, vol VIII. IARC, Lyon
Etzioni DA, Beart RW Jr, Madoff RD, Ault GT (2009) Impact of the aging population on the demand for colorectal procedures. Dis Colon Rectum 52:583–591
Schmitt C (2004) Treatment strategies for colorectal cancer in the elderly. J Clin Gastroenterol 38:387–389
Sobin LH, Wittekind C (eds) (1997) UICC TNM classification of malignant tumours, 5th edn. New York, Wiley
Jass JR, Sobin LH (1989) Histologic typing of intestinal tumours. In: Sobin LH (ed) World Health Organisation. International classification of tumours, 2nd edn. Springer, Berlin
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of survey. Ann Surg 240:205–213
Mäkelä JT, Laitinen ST, Kairaluoma MI (1995) Five-year follow-up after radical surgery for colorectal cancer. Arch Surg 130:1062–1067
Goodwin JS, Samel JM, Hunt WC (1996) Determinants of survival in older cancer patients. J Nath Cancer Inst 88:1031–1038
Colorectal Cancer Collaborative Group (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 356:968–974
Nascimbeni R, Di Fabio F, Di Betta E, Salemi B (2009) The changing impact of age on colorectal cancer surgery. A trend analysis. Colorectal Dis 11:13–18
Basili G, Lorenzotti L, Biondi G, Preziuso E, Angrisano C, Carnrsecchi P, Goletti G (2008) Colorectal cancer in the elderly. Is there a role for safe and curative surgery? ANZ J Surg 78:466–470
Faivre J, Lemmens VEPP, Quipourt V, Bouvier AM (2007) Management and survival of colorectal cancer in the elderly in population-based studies. Eur J Cancer 43:2279–2284
Morris EJ, Taylor EF, Thomas JD, Quirke P, Finan PJ, Coleman MP, Rachet B, Torman D (2011) Thirty-day mortality after colorectal cancer surgery in England. Gut 60:806–813
Heriot AG, Tekkis PP, Smith JJ, Cohen CR, Montgomery A, Audisio RA, Thompson MR, Stamakis JD (2006) Prediction of postoperative mortality in elderly patients with colorectal cancer. Dis Colon Rectum 49:816–824
Al-Refaie WB, Parsons HM, Henderson WG, Jensen EH, Tuttle TM, Vickers SM, Rothenberger DA, Virnig BA (2010) Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg 251:311–318
Greenburg AG, Saik RP, Pridham D (1985) Influence of age on mortality of colon surgery. Am J Surg 150:65–70
Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Kori T, Nakajima H, Asao T, Kuwano H (2004) Should patients over 85 years old be operated on for colorectal cancer? J Clin Gastroenterol 38:408–413
Pedrazzani C, Cerullo G, De Marco G, Marrelli D, Neri A, De Stefano A, Pinto E, Roviello F (2009) Impact of age-related comorbidity on results of colorectal cancer surgery. World J Gastroenterol 15:5706–5711
Al-Refaie WB, Parsons HM, Habermann EB, Kwaan M, Spencer MP, Henderson WG, Rothenburger DA (2011) Operative outcomes beyond 30-day mortality: colorectal cancer surgery in the oldest old. Ann Surg 253:947–952
Ong ES, Alassas M, Dunn KB, Rajput A (2008) Colorectal cancer surgery in the elderly: acceptable morbidity? Am J Surg 195:344–348
Tan E, Tilney H, Thompson M, Smith J, Tekkis PP (2007) The United Kingdom National Bowel Cancer Project—epidemiology and surgical risk in the elderly. Eur J Cancer 43(2285):2294
Devesa JM, Morales V, Enriquez JM, Nuno J, Camunas J, Hernandez MJ, Avila C (1988) Colorectal cancer. The bases for a comprehensive follow-up. Dis Colon Rectum 31:636–652
Smith JJ, Lee J, Burke C, Contractor KB, Dawson PM (2002) Major colorectal cancer resection should not be denied to the elderly. EJSO 28:661–666
Dekker JW, van der Broek CB, Bastiaannet E, van de Geest LG, Tollenaar RA, Liefers GJ (2011) Importance of the first postoperative year in the prognosis of elderly colorectal cancer patients. Ann Surg Oncol 18:1533–1539
Zlobec I, Lugli A (2008) Prognostic and predictive factors in colorectal cancer. J Clin Pathol 61:461–569
Stilwell AP, Buettner PG, Siu SK, Stitz RW, Stevenson AR, Ho YH (2011) Predictors of postoperative mortality, morbidity, and long-term survival after palliative resection in patients with colorectal cancer. Dis Colon Rectum 54:535–544
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mäkelä, J.T., Kiviniemi, H. Surgical treatment of colorectal cancer in patients aged over 80 years. Int J Colorectal Dis 27, 1055–1060 (2012). https://doi.org/10.1007/s00384-012-1427-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-012-1427-5