Prognosis of elderly patients with large bowel cancer

Abstract

The effect of age on the presentation, diagnosis, management and survival of patients with colorectal cancer was studied prospectively in 512 patients admitted to a single institution. In all, 225 patients were aged 70 years or more and 287 less than 70 years. Older patients had a significant excess of emergency presentations (18 versus 11 per cent). Methods of diagnosis, proportion of curative operations performed, stage and histological grade were similar in the two age groups. The postoperative mortality rate was 6 per cent in the elderly group and 3 per cent in younger patients. The postoperative mortality rate rose to 15 and 12 per cent respectively in those undergoing emergency surgery. The relative 5-year survival rate standardized for age and sex was 52 per cent for older patients and 45 per cent for younger patients; for those undergoing curative surgery it was 68 and 59 per cent respectively. The behaviour of colorectal carcinoma changes little with age and, allowing for population mortality, age has no effect on the long-term survival of elderly patients with large bowel cancer.

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

“…This is a political decision that a physician should not have to face (Sulmasy, 1992). It has been demonstrated that strategies to improve the prognosis of colorectal cancer should not exclude the older patients (Mulcahy et al, 1994), and our small prospective series contributes to this conclusion. This is a small series of data, but one that deals with an important area.…”

“…A difference in the clinical presentation is being reported (Arnaud et al, 1991) as a consequence of a twofold increase in right-sided cancers, which are responsible for occult bleeding, occlusion and nutritional impairment. Obstructing tumours are significantly more common in patients over 70 years of age (Korenaga et al, 1991), requiring emergency operation; this is associated with a significantly higher incidence of operative deaths at any age (Turunen et al, 1983;Irvin, 1988), but the prevalence of operative morbidity and mortality among the aged on emergency is significantly higher than for younger patients under the same conditions, in both eastern and western series (Korenaga et al, 1991;Mulcahy et al, 1994). When only elective operations are considered, any difference in operative deaths recorded in the two age groups is small, ranging from 4% to 7% (Arnaud et al, 1991;Mulcahy et al, 1994).…”

“…Obstructing tumours are significantly more common in patients over 70 years of age (Korenaga et al, 1991), requiring emergency operation; this is associated with a significantly higher incidence of operative deaths at any age (Turunen et al, 1983;Irvin, 1988), but the prevalence of operative morbidity and mortality among the aged on emergency is significantly higher than for younger patients under the same conditions, in both eastern and western series (Korenaga et al, 1991;Mulcahy et al, 1994). When only elective operations are considered, any difference in operative deaths recorded in the two age groups is small, ranging from 4% to 7% (Arnaud et al, 1991;Mulcahy et al, 1994). Kingston et al (1995) recorded a significant increase in the length of hospital stay in the over 75 age group (16 vs 13 days), although post-operative wound infection and leak rates were not significantly different: this was explained by a more detailed timeconsuming preoperative evaluation.…”

“…Kingston et al (1995) recorded a significant increase in the length of hospital stay in the over 75 age group (16 vs 13 days), although post-operative wound infection and leak rates were not significantly different: this was explained by a more detailed timeconsuming preoperative evaluation. Finally, survival is better for younger patients, but this difference loses statistical significance when survival curves plotted for patients undergoing potentially curative surgery and malignant deaths are considered (Mulcahy et al, 1994). This stimulated our interest in assessing the difference in the economical burden when delivering radical surgery to the aged colorectal cancer patient vs younger ones, in order to address a common clinical problem.…”

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

“…Emergency colon surgery itself had a higher mortality rate than non-emergency colon surgery [2,[12][13][14]. The present study is of potential interest because sepsis is a very common problem in elderly patients who undergo emergency colorectal surgery.…”