Surgery of colorectal carcinoma in patients aged over 80.
BACKGROUND
The incidence of colorectal carcinoma increases rapidly in aged patients. We investigated retrospectively the differences in treatment relative to the patients' age.


METHODS
A total of 394 patients with colorectal carcinoma (group I: > or =80 years, n = 197; group II: 60-79 years, n = 197) were analyzed in an average period of 4 years in relation to surgery, comorbidities, postoperative morbidity, mortality, survival and recurrence.


RESULTS
Patients > or =80 years had a significantly higher rate of comorbid conditions (p = 0.04; cardiovascular, p = 0.01; diabetes mellitus, p < 0.05) and more carcinomas in the sigmoid/rectum (72% vs. 67%; p < 0.05). Tumor stage, R0 resection rate, and overall complication rate were not influenced by age. The 30-day mortality rate was significantly higher in group I (12% vs. 3%; p = 0.02). Emergency surgical procedures were required significantly more often in group I (14%) than in group II (5%; p = 0.003). The 5-year survival rate among patients in group I was 30.1% compared to 50.5% among patients in group II (p < 0.0001).


CONCLUSIONS
Elderly patients have a higher rate of comorbidity and a higher postoperative 30-day mortality rate. Tumor stage, R0 resection rate, and overall postoperative complication rate do not appear to be influenced by age. The higher rate of emergency operations on patients > or =80 years is associated with the higher 30-day mortality. Even in patients aged > or =80 years, attention should focus on the long-term oncological results, after appropriate assessment of the preoperative risk.
Falch
Claudius
C
Department of Surgery, Comprehensive Cancer Center, University of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen, Germany.
Kratt
Thomas
T
Beckert
Stefan
S
Kirschniak
Andreas
A
Zieker
Derek
D
Königsrainer
Ingmar
I
Löb
Stefan
S
Hartmann
Joerg T
JT
Königsrainer
Alfred
A
Brücher
Bjorn L D M
BL
D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome