title: Curative colorectal resections in patients aged 80 years and older: clinical characteristics, morbidity, mortality and risk factors.
abstract: BACKGROUND
  The management of colorectal cancer in the elderly presents unique challenges. The objective of this study was to determine outcomes following curative colorectal resection in patients aged 80 years and older.
  
  
  METHODS
  Study design is retrospective. Data were extracted from the university hospital database and medical records of patients aged 80 years and older operated between April 2004 and December 2009. Intervention was curative colorectal resection. Main outcome measures include postoperative morbidity, mortality and individual risk factors associated with them.
  
  
  RESULTS
  Three hundred fifty-eight patients (43.8% males, age = 84 ± 3 years) were included; 72.6% received elective surgery. A significantly higher complication rate and 30 day, 1 year and 4 year mortality were present for emergency operations compared to elective (p < 0.001). One-year survival was 65.0% for elective resections and 55.1% for emergency. At 4 years of follow-up, survival was 49.2% for the elective vs. 27.6% for emergency. The American Society of Anesthesiologists (ASA) score is the only factor associated with the 30-day mortality at the multivariate analysis (p < 0.01), Dukes staging with overall mortality (p < 0.005), sex and mode of the operation with major complications (p < 0.05). A limitation of the study is that is retrospective.
  
  
  CONCLUSIONS
  The highest mortality rates following colorectal surgery in the elderly are in the early postoperative period, especially for emergency operations and patients with significant comorbidities. However, the 1-year survival following elective curative resection for colorectal cancer approaches 65 %. ASA score and modality of the operation (elective vs. emergency) impacted on postoperative mortality and morbidity and could be used to select patients with more favourable outcomes.
authors.affiliation: Department of Colorectal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK. ugoihedioha@hotmail.com
authors.forename: Ugochukwu
authors.initials: U
authors.lastname: Ihedioha
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Gravante
authors.forename: Geraint
authors.initials: G
authors.lastname: Lloyd
authors.forename: Sam
authors.initials: S
authors.lastname: Sangal
authors.forename: Roberto
authors.initials: R
authors.lastname: Sorge
authors.forename: Baljit
authors.initials: B
authors.lastname: Singh
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chaudhri
mesh_terms: D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D003710:Demography; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology