Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish rectal cancer registry 1995–2004

Abstract

BackgroundLimited information is available regarding the effect of age on choice of surgical and oncological treatment for rectal cancer. The objective of this study was to assess the influence of age on treatment and outcome of rectal cancer.MethodsWe utilized data in the Swedish Rectal Cancer Registry (SRCR) from patients treated for rectal cancer in Sweden in 1995–2004.ResultsA total of 15,104 patients with rectal cancer were identified, 42.4% of whom were 75 years or older. Patients ≥75 years were less likely to have distant metastases than younger patients (14.8% vs. 17.8%, P < 0.001), and underwent abdominal tumor resection less frequently (68.5% vs. 84.4%, P < 0.001). Of 11,725 patients with abdominal tumor resection (anterior resection [AR], abdominoperineal excision [APE], and Hartmann's procedure [HA]), 37.4% were ≥75 years. Curative surgery was registered for 85.0% of patients ≥ 75 years and for 83.9% of patients < 75 years, P = 0.11. Choice of abdominal operation differed significantly between the two age groups for both curative and non-curative surgery, The frequency of APE was similar in both age groups (29.5% vs. 28.6%), but patients ≥75 years were more likely to have HA (16.9% vs. 4.9%) and less likely to have preoperative radiotherapy (34.3vs. 67.2%, P < 0.001). The relative survival rate at five years for all patients treated with curative intent was 73% (70–75%) for patients ≥75 years and 78% (77–79%) for patients < 75 years of age. Local recurrence rate was 9% (8–11%) for older and 8% (7–9%) for younger patients.ConclusionTreatment of rectal cancer is influenced by patient's age. Future studies should include younger and older patients alike to reveal whether or not age-related differences are purposive. Local recurrence following surgery for low tumors and quality of life aspects deserve particular attention.

The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study

“…In contrast to our findings, several studies did observe less surgical treatment performed in older patients [7,8,[20][21][22][23][24]. Also, higher rates of non-surgical complications, mainly cardiopulmonary, in older patients have been reported [7,8,20,26].…”

“…Deviation from standard treatment in older patients with rectal cancer and comparable postoperative complication rates with younger patients are reported previously [7,[20][21][22][24][25][26]. In contrast to our findings, several studies did observe less surgical treatment performed in older patients [7,8,[20][21][22][23][24].…”

Impact of pre-treatment patient-related selection parameters on outcome in rectal cancer

“…14e16 Earlier studies have pointed out the absence of high quality evidence on how to treat elderly and comorbid patients. 17,18 However, despite the risk of an increased proportion of treatmentrelated complications in the elderly population or in patients with significant comorbidity, there are results indicating that also these patients gain from preoperative treatment. 9,12,19 In an earlier study we found that not only undertreatment is a problem in the selection process to preoperative treatment.…”

Clinical outcome of rectal cancer in patients ≥ 80 years treated in southern France (PACA region) between 2002 and 2005

“…When analyzing the "Dutch TME" trial [17] and the Dutch cancer registries, Rutten et al [24] reported a low survival rate after radical surgery for patients >75 years and no benefit from the TME surgery. The death rate during the 6 months after surgery was close to 25% above the age of 80 years.…”

“…Thus, it is difficult to define a standard approach for these elderly patients and to know what their outcome is. In a Swedish study, treatment of patients >70 years appeared suboptimal with less preoperative radiotherapy and more Hartman procedures with permanent stoma [17]. Only a few short reports deal with patients aged 70 years or above [19] or 80 years or above [11].…”