Outcomes of surgery for mid and distal rectal cancer in the elderly

This study aimed to evaluate the surgical strategies, operative results, and oncological outcomes of elderly patients who underwent curative resection for mid and distal rectal cancer. Comparison was made with patients of younger age.

Of the 612 patients who underwent curative resection for rectal cancer, 133 were older than 75 years of age. Comparisons were made between the young and elderly patients in the aspects of operative strategies, operative results, and long-term outcomes.

Resection resulting in a permanent end colostomy was performed in 96 patients (15.7%), and there was no difference between young and elderly patients. There was a female predominance in the elderly group. Elderly patients also had a higher incidence of comorbid medical diseases, especially cardiovascular and neurological diseases. The operative time, blood loss, and incidence of intraoperative complications did not differ in the two groups. However, significantly fewer elderly patients underwent adjuvant radiation and/or chemotherapy. The overall 30-day mortality was 1.14%. There was no difference between the elderly patients and younger patients in hospital mortality (P = 0.178). The complication rates of the elderly and young patients were 36.8% and 30.1%, respectively (P = 0.141). Comparison between the individual complications in the elderly and young patients revealed significantly more cardiovascular complications in the elderly patients. With the median follow up of the surviving patients of 45.1 months, the overall 5-year survival of the elderly and younger groups was 47.7% and 70.1%, respectively (P < 0.001). The 5-year cancer-specific survival was 75.4% and 67.5% in the young and elderly patients, respectively (P = 0.061).

Curative resection for mid and distal rectal cancer for the elderly can be performed safely with the same strategies of sphincter preservation used for younger patients. The postoperative complications and the 5-year cancer-specific survival rates were similar to those of younger patients.