Colorectal cancer in the elderly: surgical treatment and long-term survival

The prognosis of radical treatment for colorectal cancer in elderly patients has been subject of controversies. The aim of this study was to compare patients at the age of 75 years or older with a group of younger patients, focused on the clinicopathologic characteristics and the results of radical treated colorectal cancer.

A retrospective study was made to evaluate age-related surgical risk and outcome. The following criteria were analyzed in two age groups (<75 years and > or =75 years): comorbidities, tumor characteristics, type of resection, postoperative morbidity and mortality, recurrence rate, overall survival, cancer-related survival, and disease-free survival.

Altogether, 517 patients were included into the study. Gender, ASA risk score, frequency of concomitant comorbidities, and tumor location differed significantly between the two age groups. Tumor characteristics were equal between the two groups. There were no differences in 30-day morbidity except in postoperative bleeding, but 30-day mortality was higher in the older age group. Mean time of follow-up was approximately 32 months. Frequencies for adjuvant, as well as for palliative (radio-) chemotherapy were lower in the older group. While cancer-related survival was lower in the higher age group, there were no differences in disease-free survival.

The age of patients does not seem to be a prognostic factor for perioperative results; furthermore, the long-term results rather depend on the stage of disease and on adjuvant or palliative treatment, respectively, than on age.