Safety of bowel resection for colorectal surgical emergency in the elderly.
OBJECTIVE
Colorectal emergency requiring radical surgery is becoming increasingly frequent in the elderly and problems remain as regards the best management policy. Our long-time experience is presented in this study.


METHODS
In the last 23 years, 105 elderly patients, aged > or = 65 years, with colorectal disease underwent an emergency operation in our Surgical Department. Forty-five patients (mean age 72 years) had benign disease and 60 patients (mean age 76.5 years) colorectal carcinoma.


RESULTS
The carcinoma was located in the left colon (68%), right colon (18%) and rectum (14%). Mostly, patients with malignant cancer presented with obstructive ileus, and patients with benign tumours with perforation and peritonitis, with a predominance of diverticulitis. A resection operation either with primary anastomosis or Hartmann's procedure was performed in 75% of cases; in the rest, only palliation was resorted to. Forty-three percent of the patients with colorectal cancer emergency were > or = 80 years of age. The mean morbidity was 25% and mortality 17%, which make up to 33% and 26.6% for benign disease, and 20% and 10% for malignant cancer, respectively. The mortality rate was higher in patients with perforation than those with obstruction.


CONCLUSIONS
Advanced age is not a contraindication to radical surgery in case of colorectal emergency in the elderly. In the majority, a resection operation is feasible. In high-risk patients, colostomy is a life-saving alternative.
Pavlidis
T E
TE
Second Surgical Propedeutical Department, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 54642 Thessaloniki, Greece. pavlidth@med.auth.gr
Marakis
G
G
Ballas
K
K
Rafailidis
S
S
Psarras
K
K
Pissas
D
D
Papanicolaou
K
K
Sakantamis
A
A
D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000401:mortality; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000401:mortality; D004638:Emergency Treatment / Q000009:adverse effects*; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D010538:Peritonitis / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome