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Survival after operations for colorectal cancer in patients aged 75 years or over
J T Mäkelä1, H Kiviniemi, S Laitinen
1Department of Surgery, Oulu University Hospital, Finland.
Objective:
To define factors that predict mortality and survival in patients with colorectal cancer who are aged 75 or over.
Design:
Retrospective study.
Setting:
University hospital, Finland.
Subjects:
231 patients aged 75 or over who were admitted to hospital with colorectal cancer during the 14-year period 1980-93.
Main Outcome Measures:
Morbidity, mortality, recurrence, and survival.
Results:
In-hospital mortality after any kind of operation was 8/211 (4%), and 8/175 (5%) of those who had their tumours resected. Morbidity was 35/175 (20%). Factors associated with mortality were weight loss, Dukes'stage, extent of resection, and type of operation. Overall 5-year survival was 28%, overall 10-year survival was 4%, and median survival was 33 months (range 0-150). Survival was most closely related to Duke's stage, extent of resection, and recurrent disease on univariate analysis, but multivariate analysis identified only mode of recurrence (p < 0.0001), recurrent disease (p < 0.004), and extent of resection (p < 0.009) as independent predictors of survival. The recurrence rate after radical resection was 49/141 (35%) and the median disease-free interval was 10 months (range 4-64). Mortality after resection for recurrent cancer was 3/17 (18%) and morbidity 5/17 (29%).
Conclusion:
Age alone is not a risk factor for postoperative mortality or a predictor of long-term survival. Low mortality and acceptable long-term survival can be achieved in patients aged 75 or over if those with extensive distant metastases, and those whose general condition is too poor to stand a major operation, are treated conservatively.