Management of colon cancer in the elderly: a population-based study.
OBJECTIVE
Although the median age of patients diagnosed with colon cancer is over 70 years, little is known about specific characteristics and management in the elderly. The aim of this study was to define the characteristics of colon cancer in elderly patients and compare the quality of preoperative assessment and surgery with that of younger patients undergoing surgery for colon cancer.


METHODS
Data on 15,255 patients diagnosed with colon cancer between 2007 and 2010 were retrieved from the Swedish National Colon Cancer Register. Of these, 12,959 underwent surgical resection: 6141 were 75 years or older while 6818 were younger. The χ(2) test, Mann-Whitney U-test and univariable and multivariable logistic regression analyses were used for between-group comparison.


RESULTS
Older patients were more likely to be female (54% older/48% younger) and have right-sided cancer (60% older/49% younger). Among patients who underwent resection, the elderly were less often evaluated regarding tumour stage prior to surgery (59% older/65% younger) and they were less often evaluated at a multidisciplinary team conference (26% older/34% younger). Elderly patients more frequently underwent emergency surgery (22% older/19% younger) despite having an earlier cancer stage. When adjusted for stage, fewer elderly patients underwent a radical curative procedure (OR for noncurative resection 1.19; 95% CI 1.06-1.33).


CONCLUSIONS
Routine management of patients with colon cancer is age-dependent. Patients aged 75 years and older are less often completely staged and less often evaluated at a multidisciplinary team conference prior to surgery. Adjusted for stage, fewer elderly patients undergo curative resection.
CLINTEC, Karolinska Institutet, Stockholm, Sweden; Department of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden.
M
M
Egenvall
K
K
Schubert Samuelsson
I
I
Klarin
J
J
Lökk
A
A
Sjövall
A
A
Martling
U
U
Gunnarsson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D003110:Colonic Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011159:Population Surveillance; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
Cancer; epidemiology; surgery