The influence of age on the outcome of treatment of elderly patients with colorectal cancer.
OBJECTIVE
We investigated factors associated with post-operative mortality rates in those aged ≥60, and in particular, the relative survival of age bands within this group.


METHODS
Secondary analysis of a large comprehensive cohort of the elderly treated for colorectal cancer in the North of England during 1998-2003. We investigated seven risk factors associated with 30-day and 6-month post-operative mortality from colorectal surgery.


RESULTS
6083 patients aged ≥60 underwent colorectal cancer surgery. Approximately 8% had died within 30 days of surgery and 17% had died within 6 months. Thirty-day mortality was greater in the elderly (80 years+) compared to the young-old (60-69 years) (adjusted OR: 3.2, 95% CI 2.4 to 4.4). There was neither a significant difference between the proportions offered curative resections across the age-groups, nor was there a significant association between intent of surgery and 30-day mortality. Six-month mortality rose with age, but the association was stronger in those having curative surgery (adjusted OR: 3.8, 95% CI 2.8 to 5.2) than palliative surgery (adjusted OR: 1.5, 95% CI 1.1 to 2.1). Mortality from emergency surgery at 6-months was particularly high in elderly females.


CONCLUSIONS
This large population study adds more weight to the findings that age itself is a major risk factor in the outcome of colorectal surgery in elderly and that 30-day mortality underestimates the longer-term outcome in this age group. There was no significant association between radical resections and 30-day mortality in elderly patients compared to the younger age groups; however, a disproportionately higher mortality at 6 months was seen in elderly female patients.
Darlington Memorial Hospital, Hollyhurst Road, Darlington DL3-6HX, UK. Electronic address: drahmedsohail@yahoo.com.
Sohail
S
Ahmed
Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle-upon-Tyne NE2-4AX, UK. Electronic address: denise.howel@ncl.ac.uk.
Denise
D
Howel
Darlington Memorial Hospital, Darlington DL3-6HX, UK. Electronic address: sdebrah@aol.com.
Samuel
S
Debrah
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000401:mortality; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome
Elderly