title: Surgery for Colorectal Cancer in Elderly Patients: How Could We Improve Early Outcomes ?
abstract: BACKGROUND
  Age is one of the causes behind the undertreatment of elderly colorectal cancer patients. The increase of mortality among elderly colorectal cancer (CRC) patients is due to competing causes of death occurring in the early post operative period. The purpose of this study was to evaluate the risk factors for post operative mortality and morbidity among elderly CRC patients.
  
  
  METHODS
  A retrospective descriptive chart review was performed on consecutive patients older than 70 y with CRC. We have collected data of 124 patients who were admitted from January 2001 to January 2010. Demographic characteristics, operative and postoperative informations were retrospectively analysed.
  
  
  RESULTS
  Early postoperative morbidity, operation related to morbidity and mortality were observed in 44 (35.5%), 9 (7.3%) and 20 (16.1%) cases, respectively. No other factors but ASA score (p = 0.002 and 0.005 in univariate and multivariate analyses, respectively) and emergency operations (p<0.001 and 10(-3) in univariate and multivariate analyses, respectively), were found to be risk factors of mortality. The results of multivariate analyses indicated that anaemia (p=0.021) and rectal cancer (p=0.015) had significant impact on the risk of anastomotic leakage. On the other hand, diabetes mellitus and rectal cancer were indicators that correlated with the width of hospitalization.
  
  
  CONCLUSIONS
  Elderly CRC patients should no longer be undertreated only because of their age. They should be exposed to more aggressive management than they are currently receiving. Careful preoperative evaluation, followed by medical optimization and planning of perioperative care could improve outcomes of colorectal surgery for elderly patients.
authors.affiliation: Professor, Department of Surgery , Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .
authors.forename: Mahdi
authors.initials: M
authors.lastname: Bouassida
authors.affiliation: Faculty, Department of Anaesthesiology, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .
authors.forename: Hédi
authors.initials: H
authors.lastname: Charrada
authors.affiliation: Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .
authors.forename: Mohamed Fadhel
authors.initials: MF
authors.lastname: Chtourou
authors.affiliation: Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .
authors.forename: Lamine
authors.initials: L
authors.lastname: Hamzaoui
authors.affiliation: Student, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .
authors.forename: Mohamed Mongi
authors.initials: MM
authors.lastname: Mighri
authors.affiliation: Professor, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .
authors.forename: Selim
authors.initials: S
authors.lastname: Sassi
authors.affiliation: Student, Department of Gastro Enterology, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .
authors.forename: Mohamed M'Saddak
authors.initials: MM
authors.lastname: Azzouz
authors.affiliation: Student, Department of Surgery, Mohamed Tahar Maamouri, Hospital , Mrezga 8000, Nabeul, Tunisia .
authors.forename: Hassen
authors.initials: H
authors.lastname: Touinsi
keywords: Geriatric; Morbidity; Mortality