Colorectal cancer in the elderly. Is there a role for safe and curative surgery?

Recent reports place colorectal cancer (CRC) as the third most common cancer for both sexes. Elderly patients are often viewed as high-risk surgical candidates with high rates of emergency presentations and perioperative mortality. The aim of our study was to examine the characteristics and perioperative morbidity and mortality rates of elderly patients presented to CRC surgery.

We retrospectively studied 248 patients who underwent surgery for CRC at our institution between July 2003 and December 2005. Risk factors included sex, age, cancer localization, Dukes' and TNM classification, blood transfusion, preoperative Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity score and mode of presentation. Primary outcome was perioperative death.

The study consisted of 143 men and 105 women. One hundred and thirty-four (54%) patients were more than 75 years of age. In the two older groups, cancer was more common in the proximal colon than in the youngest age group (P = 0.001). Of the 25 resections carried out as emergency, 20 were in those who were more than 75 years of age (P < 0.001). In elective procedure, perioperative mortality scores were 3.1% in those who were more than 75 years of age versus 0% in those less than 75 years, meanwhile in emergency, rates of 24 versus 0% (P = not significant) were registered. In Cox multivariate regression analysis, age and mode of presentation reached statistical significance.

Old age itself is not an independent negative prognostic factor for CRC surgery. Although emergency operations were associated with poor outcome, most patients survived and left the hospital. This study suggests that, whenever possible, curative intent should be applied in patients with CRC, irrespective of the age.