The changing impact of age on colorectal cancer surgery. A trend analysis.
OBJECTIVE
The aim of the study was to evaluate the changing influence of age on the outcomes of colorectal cancer surgery in a retrospective trend analysis.


METHODS
Data on 985 patients undergoing colorectal cancer surgery were collected during 1975-1984 and 1995-2004. Variables and outcomes of patients aged < 65, 65-74, 75-84 and 85+ years were compared with intra- and interdecade analyses. Endpoints of the study were postoperative mortality, 5-year overall and cancer-related survivals.


RESULTS
The rate of elderly patients undergoing colorectal cancer surgery increased significantly from 1975-1984 to 1995-2004. Distribution of American Society of Anesthesiology score and cancer stage remained unchanged over time. The rate of palliative procedures decreased over time, most significantly in the older age groups. In 1995-2004 the palliation rate was similar across all age groups. The rate of emergency surgery also decreased, but it remained higher in older age groups. Operative mortality rate decreased over time across all age groups, but age-related differences were still observed in the 1995-2004 series. Cancer-related survival after curative surgery increased from 58% in 1975-1984 to 64% in 1995-2004 in 75+ years patients, while it increased from 56% to 78% in patients aged 74 years or younger.


CONCLUSIONS
Elderly patients with colorectal cancer benefited substantially from healthcare progress during the last 30 years. The reduction of palliative procedures and the decline in operative mortality document the efficacy of not restricting the access to radical surgery for these patients.
Nascimbeni
R
R
Cattedra di Chirurgia Generale, Department of Medical & Surgical Sciences, University of Brescia, Brescia, Italy. nascimbr@med.unibs.it
Di Fabio
F
F
Di Betta
E
E
Salerni
B
B
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality* / Q000639:trends*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000639:trends; D012189:Retrospective Studies