The United Kingdom National Bowel Cancer Project -- epidemiology and surgical risk in the elderly.
OBJECTIVE
To evaluate the epidemiology and risk of surgery in the treatment of colorectal cancer in the elderly.


METHODS
Patients undergoing colorectal cancer surgery were identified from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) bowel cancer database, comprising 47,455 patients treated over a 5-year period. Demographic characteristics and outcomes were compared between patients aged <75 and those 75 or above. The primary endpoint was 30-day mortality. Secondary endpoints were the length of hospital stay, abdominoperineal excision (APER) rates and lymph node harvest.


RESULTS
Elderly patients were likely to be female and have higher American Society of Anaesthesiology (ASA) grade, while Dukes' stage was lower. They underwent surgery less often (81% versus 88%, p<0.001), but more frequently needed urgent or emergency procedures (p<0.001) and non-excisional surgery (7.7% versus 6.6%, p<0.001). Operative mortality was significantly higher for the older age group (10.6% versus 3.8%, p<0.001), and their median length-of-stay was 2 days longer (p<0.001). Mortality has improved over time for elderly patients with ASA grade III, and Dukes' stage A and D disease, but not for other subgroups.


CONCLUSIONS
Significant differences in the demographic characteristics and operative risk-factors between under-75s, and those aged 75 or above exist. These variations are reflected in the inferior outcomes experienced by elderly patients.
Tan
Emile
E
Imperial College, Department of Biosurgery & Surgical Technology, 10th Floor, QEQM, St. Mary's Hospital, Praed Street, London W2 1NY, UK.
Tilney
Henry
H
Thompson
Mike
M
Smith
Jason
J
Tekkis
Paris P
PP
D017677:Age Distribution; D000368:Aged; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D009026:Mortality / Q000639:trends; D011788:Quality of Life; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology