Survival outcome of operated and non-operated elderly patients with rectal cancer: A Surveillance, Epidemiology, and End Results analysis.
BACKGROUND
With an ageing population, surgery is increasingly offered to elderly patients with rectal cancer, although outcomes for the oldest patients remain poorly defined. This study aimed to determine whether operative intervention improves outcome in elderly patients.


METHODS
Patients aged 18+ years diagnosed with rectal adenocarcinoma between 1998 and 2009 were identified from the Surveillance, Epidemiology, and End Results database. The primary endpoint was adjusted hazard ratios (HR) for 5-year cancer specific survival (CSS); the secondary endpoint was 5-year overall survival (OS).


RESULTS
With increasing age, patients were less likely to undergo surgery, receive a complete stage or receive neoadjuvant radiotherapy. CSS and OS increasingly diverged with age in patients undergoing surgery. Those aged 80+ had reduced CSS compared to those aged 70-79 years (stages I-III, respective adjusted HR 2.14, 1.58, 1.48, all p < 0.001). However, stage II patients aged 80+ treated with resection and neoadjuvant therapy had similar survival to those aged 70-79 years (adjusted HR 1.26, p = 0.149). For only patients aged 80+ years, those treated non-operatively had lower survival than those undergoing surgery, who in turn had the best survival when treated with neoadjuvant radiotherapy (adjusted HR 0.74, p = 0.001).


CONCLUSIONS
Contrary to common expectation, in patients aged over 80 with rectal cancer, surgery with or without other modalities was associated with better survival than non-operative treatment. Despite selection bias in this observational study, these findings support consideration of maximal therapy regardless of age in selected patients deemed to be fit, since this leads to outcomes equivalent to younger patients.
Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London, UK; Division of Surgery, Imperial College, Chelsea and Westminster Campus, London, UK.
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Bhangu
Division of Colorectal Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, USA.
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Kiran
Department of Surgery, University of Liverpool, Liverpool, UK.
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Audisio
Department of Colorectal Surgery, Royal Marsden Hospital, Fulham Road, London, UK; Division of Surgery, Imperial College, Chelsea and Westminster Campus, London, UK. Electronic address: p.tekkis@imperial.ac.uk.
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Tekkis
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D055815:Young Adult
Elderly; Rectal cancer; SEER; Staging; Surgical outcomes