Impact of octogenarians on surgical outcome in colorectal cancer.
OBJECTIVE
Colorectal cancer's (CRC) incidence occupies the second place among malignant tumours in men and the third place in women. The aging of the population raises new questions on the management of CRC in octogenarian patients. The objective of this study was to assess the influence of age (≥80) on treatment and surgical outcome of colorectal cancer.


METHODS
In the period between October 1995 and April 2014, a total of 1397 patients underwent emergency and elective surgical interventions for CRC; the first group (Group-Older - GO) was composed of 291 patients 80 years or older (20.9%, of which 46.4% were male). The second group (Group-Younger - GY) included 1106 patients younger than 80 years (79,1%, 57.7% males).


RESULTS
Significant differences between the two groups were observed regarding sex (p = 0.001), number of comorbidities (p = 0.001), ASA classification (p < 0.001), emergency presentation (p < 0.001), site of tumor (p = 0.010), need of intraoperative blood transfusions (p < 0.001), 30-days mortality (p < 0.001), 90-days mortality (p < 0.001) and morbidity in accordance with Clavien-Dindo classification (p < 0.001). When combining both elective and emergency procedures, multivariate logistic regression analysis showed that advanced age (≥80 years old) was an independent predictor factor of 30-days mortality (p = 0.023, OR = 2.23) and morbidity (p = 0.088, OR = 1.31), while it was not predictive of 90-days mortality. When considering only elective colorectal surgery, octogenarian age was not found to be a predictive factor of 30-day and 90-day mortality, but predictive of postoperative morbidity.


CONCLUSIONS
Old age (≥80) does not represent a contraindication to CRC elective surgical treatment, in emergency procedures it is associated with an increased risk of postoperative morbidity and mortality.
Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy. Electronic address: eliopirrera@virgilio.it.
Basilio
B
Pirrera
Unit of Emergency Surgery, Emergency Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Samuele
S
Vaccari
Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Dajana
D
Cuicchi
Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Ferdinando
F
Lecce
Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Emilio
E
De Raffele
Unit of Emergency Surgery, Emergency Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Barbara Dalla
BD
Via
Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Marco
M
Di Laudo
Unit of Emergency Surgery, Emergency Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Valeria
V
Tonini
Unit of Emergency Surgery, Emergency Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Maurizio
M
Cervellera
Unit of General Surgery, Medical and Surgical Department, University of Bologna, Policlinico S. Orsola-Malpighi, Italy.
Bruno
B
Cola
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
Colorectal carcinoma; Octogenarians; Surgical outcomes