Survival of elderly rectal cancer patients not improved: analysis of population based data on the impact of TME surgery.
BACKGROUND
The incidence of rectal cancer is highest in elderly patients. However, these patients are often underrepresented in randomised studies. Therefore, it is not clear whether results of rectal cancer studies are equally applicable to both elderly and younger patients. In this paper, the Dutch Total Mesorectal Excision (TME) study is revisited, focused on patients aged 75 years and above. The rectal cancer databases of the Comprehensive Cancer Centres (CCC) South and West were combined to analyse the effect of the TME-study in three different periods: before (1990-1995), during (1996-1999) and after (2000-2002) the trial.


RESULTS
Implementation of preoperative radiotherapy, as investigated in the TME trial, and the introduction of TME surgery resulted in improved 5 year survival during the subsequent periods, in patients younger than 75 years, of 60% (1990-1995) to 67% (1996-1999) and 70% (2000-2002) (log rank p<0.0001). The older patients did not improve and remained at 41%, 40% and 43% at 5 years in the respective periods. Furthermore, mortality during the first 6-month period after treatment is significantly raised compared to younger patients: 14% in the elderly, compared to 3.9% in the younger TME-study patient (p<0.0001 X2). In the CCC database these figures were confirmed at 16% and 3.9% (p<0.0001 X2).


CONCLUSIONS
Overall survival was not improved in the elderly rectal cancer patient after introduction of preoperative radiotherapy and TME-surgery. Non-cancer related mortality is a significant problem in the first 6 months after surgery.
Rutten
Harm
H
Department of Surgery, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5623 ZA Eindhoven, The Netherlands. harm.rutten@cze.nl <harm.rutten@cze.nl>
den Dulk
Marcel
M
Lemmens
Valery
V
Nieuwenhuijzen
Grard
G
Krijnen
Pieta
P
Jansen-Landheer
Marlies
M
van de Poll Franse
Lonneke
L
Coebergh
Jan-Willen
JW
Martijn
Hendrik
H
Marijnen
Corrie
C
van de Velde
Cock
C
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D009426:Netherlands / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D012004:Rectal Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D012044:Regression Analysis; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome