Elective surgery for colorectal cancer in the aged: a clinical-economical evaluation

Abstract

Summary A series of 56 consecutive patients, referred for surgery to a specialized institute, had elective laparotomies with various surgical procedures aimed at curing locoregional colorectal cancer. Data defining patient and tumour-related preoperative, operative and postoperative variables, including costs, were collected. The study group was divided into two age groups (< 65 vs . 65 years), which were similar in terms of patient-and tumour-related variables. Differences were not statistically significant (£440; 95% exact Cl; £ -50; 1800). There is no evidence to suggest that there are any total charge differences in treating the two age groups, as confirmed by the cost analysis.

Untitled

“…Clinico-economical evaluation of elective colorectal cancer in the aged independently analysed cost of preoperative investigations, operative real cost postoperative real costs and median total charges. The economic burden when delivering radical surgery to the aged colorectal cancer and younger ones were shown to be statistically no significant [147]. Five-year cancer specific survival disease free rates were not different between young and elderly.…”

“…Early reports shows that it is a viable option and some elderly patients with CRC have been treated with as part of these protocols [147]. The safety and efficacy of laparoscopy assisted colectomy remains unclear, awaiting the final results of the C linical O utcomes of S urgical t herapy (COST) trial designed to examine whether it is an effective alternative to open colectomy in the prevention of recurrence and cancer mortality [148].…”

Risk assessment for cancer surgery in elderly patients

“…These basic pathological differences will inherently affect outcome (Franceschi et al 2000). For most types of solid epithelial tumors, old age itself does not appear to function as an independently negative prognostic variable for cancer-specific survival; a finding evident in recent studies assessing colorectal cancer (Audisio, Cazzaniga, et al 1997; Staudacher et al 2000; Chiappa et al 2001), gastric cancer (Lo et al 1996; Kitamura et al 1999), esophageal carcinoma (Jougon et al 1997; Poon et al 1998), liver (Chiappa et al 1999), head & neck (Robinson 1994; Rapidis et al 1998) and breast cancers (Veronesi et al 1988; Desch et al 1993; Newschaffer et al 1996; Siliman 1996). …”

“…Age influences the predilection of cancer for disease site and histology type, ie, higher incidence of adeno-carcinoma of the distal esophagus, well-differentiated gastric tumors, right-sided colonic cancer, and low-grade lobular or mucinous type breast tumors in the elderly population have been reported (Audisio, Veronesi, et al 1997). Similarly a higher incidence of larger thyroidal tumour with Hürthle cell variant, extra-thyroidal growth and metastases at presentation are noted in elderly (Audisio and Zbar 2002).…”

Risk Factors for Adverse Outcome for Elderly Patients undergoing Curative Oncological Resection for Gastrointestinal Malignancies

“…Currently, it is understood that the older population should not be assessed on chronologic age, but rather frailty, functionality, and dependency [7,8]. The International Society of Geriatric Oncology (SIOG) task force has recommended a Comprehensive Geriatric Assessment (CGA) along with several other screening tools for evaluating an elderly patient for surgery [9,10].…”