[Clinical analysis of surgery for rectal cancer in 122 elderly patients]

Patients with rectal carcinoma in the elderly are usually complicated with coexisting diseases. For selection of operative procedure, it is necessary to consider the various factors. The aim of this study was to assess the treatment and prognosis of rectal carcinoma in patients over 65 years of age.

The data of 122 such patients treated from January 1987 to December 1998 in Cancer Hospital of Chinese Academy of Medical Sciences was analyzed retrospectively. Curative resection was performed for all patients, including abdominoperineal resection (45), anterior resection (66), Hartmann's operation (7), and transanal local excision (4). Postoperative complication developed in 10 patients (8.2%). No death occurred within 30 days post operation. Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression was used in multivariate analysis.

The overall 3- and 5- year survival rates were 76.4% and 61.0% for the whole group, 81.6% and 70.6% for the lymph node negative group (Dukes A, B), 60.9% and 40.4% for the lymph node positive group (Dukes C), respectively. The difference between the two groups was highly significant (Chi(2)=10.1, P< 0.01). However, histological type, coexisting disease, and tumor size had no significant association with prognosis (P< 0.05). Cox regression showed that lymph node metastasis was an important prognostic factor.

Suitable radical surgery are crucial for long-term survival of the elderly patients wtih rectal carcinoma. Lymph node metastasis is an important prognostic factor for rectal carcinoma in the elderly patients.