Characteristics and role of surgery in nonagenarians with colorectal cancer: SEER database analysis

As the population ages, nonagenarian patients with cancer are more frequently treated. This study aimed to assess the characteristics of colon and rectal cancer in patients aged ≥90 years and to evaluate the role of surgical intervention in this age group.

This retrospective cohort study included nonagenarian patients with colon and rectal cancer identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2020. We assessed the characteristics of nonagenarian patients with colon and rectal cancer and compared patients who underwent surgery with patients who did not undergo surgery. The main outcome measure was the effect of having surgery on overall survival and cancer-specific survival in nonagenarian patients.

A total of 23,149 nonagenarian patients were included, 65.2% of whom were female. The most common sites of cancer were the right colon (47.9%), the left colon (21.1%), and the rectum (19.1%). Early-stage colon and rectal cancer (stage I or II) accounted for 48.2% of cases. Approximately 30% of patients did not undergo any surgical intervention. Of the 89.2% patients who died, the cause was colon and rectal cancer in 42.9%. An 18- and 11-month survival benefit from having surgery was found in overall and cancer-specific survival, respectively. When stratified by tumor-node-metastasis stage, this survival benefit was more prominent in early-stage disease.

Our study indicates that nonagenarian patients with colon and rectal cancer had increased survival if they underwent surgery when compared to patients who were not surgically treated. Physicians should consider treating nonagenarian patients according to their preferences and wishes, general condition, and disease stage.