Octogenarian patients with colon cancer – postoperative morbidity and mortality are the major challenges

Abstract

Background Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. Methods All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 90-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival. Results Among 237 octogenarian patients treated with major resections with curative intent, the 90-day mortality was 9.3%. Among 215 patients that survived the first 90 days, the 5 year relative survival rate was 98.7%. The 90-day mortality of octogenarian patients was significantly higher than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 90-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 90-day and long-term survival rates improved over time. Conclusion Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 90-day mortality was high, but after surviving 90 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 90-day mortality risk.

The association of postoperative morbidity and age on 5‐year survival after colorectal surgery in the elderly population: a nationwide cohort study

“…Similar to previous studies [35][36][37], we demonstrated that postoperative complications have a negative impact on OS in all study subgroups. In accordance with our findings, a study from Norway reported higher 90-day mortality rates in octogenarian patients as well as an association with poorer 5-year survival rates [38]. Consequently, to improve long-term survival after colorectal cancer surgery future research should focus on the first 90 days after surgery, as our study indicates that this period of risk is potentially modifiable.…”

Oncologic outcomes of colorectal cancer in octogenarians

“…Elderly patients exhibit diverse prognoses based on various morbidities and general conditions. Previous studies have reported lower survival rates among elderly patients after surgery [5,14], however, other studies demonstrated comparable survival outcomes between octogenarians and younger patients [9,15,16]. Octogenarians often present with multiple comorbidities and are susceptible to unpredictable fatal illnesses, making it challenging to establish appropriate comparisons.…”

“…Some studies have suggested that elderly patients diagnosed with colorectal cancer have worse outcomes [3][4][5], while others have shown opposite [6][7][8][9]. Moreover, elderly patients are often excluded from clinical trials [10,11], and there is no consistent standard for the age criteria de ning "elderly.…”

Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old

“…Post-operative 90-day and 180-day survival was 98.1% and 93.1% in patients aged 80 to 90 years old and 98.1% and 88.9% in patients over 90 years old. In another series of 237 octogenarians, the post-operative 90-day mortality was 9.3% [ 22 ]. Factors associated with increased mortality were increasing age, high ASA score, and performance of the operation on an emergency basis.…”