Outcomes Following Colorectal Cancer Resection in Elderly Patients

Background: Colorectal cancer (CRC) mainly affects older adults, yet elderly patients are underrepresented in outcomes research. Accurate risk stratification tools, such as the Charlson Comorbidity Index (CCI), are essential for guiding surgical decisions in this group. Methods: We conducted a retrospective review of patients aged 75 years or older who underwent colorectal cancer resection at a tertiary centre between January 2019 and September 2024. Clinical, pathological, and molecular data were analyzed. The primary outcome was a composite of major postoperative complications (Clavien-Dindo grade 3 or higher) or 30-day mortality, stratified by CCI (5 or higher vs. less than 5). Statistical tests included chi-square, Fisher's exact, and Mann-Whitney U as appropriate. Results: The median age was 81 years (range 75-97), with 59.7% male. CCI ≥ 5 was observed in 24.6% (51/211). The primary composite outcome of major postoperative complications or 30-day mortality occurred in 15/51 (29.4%) patients with a CCI ≥ 5 compared to 19/160 (11.9%) with a CCI < 5 (p = 0.04). Major complications occurred in 18.5% (39/211) of cases, and the 30-day mortality rate was 3.3% (7/211). Laparoscopic resection was independently protective in multivariate analysis (adjusted OR 0.37, p = 0.048), while age ≥85 and emergency presentation were not statistically significant predictors. Conclusions: Colorectal resection in patients aged ≥75 is linked with acceptable morbidity and low short-term death rates. A CCI ≥ 5 significantly predicts adverse outcomes and should be included in preoperative assessments. Minimally invasive surgery seems advantageous and should be considered, when possible, to enhance results in this high-risk group.