Should we resect colorectal cancer in patients over the age of 85?

Abstract

BACKGROUND The prevalence of colorectal cancer in the elderly is rising, with increasing numbers of older patients undergoing surgery. However, there is a paucity of information on the surgical outcomes and operative techniques used in this population. AIM To evaluate the post-operative outcomes for patients ≥ 85 years old following colorectal cancer resection as well as evaluating the outcomes of laparoscopic resection of colorectal cancer in patients over 85. METHODS Patients who underwent colorectal cancer resection at our institution between January 2010 and December 2018 were included. The study was divided into two parts. For part one, patients were divided into two groups based on age: Those age ≥ 85 years old ( n = 48) and those aged 75-84 years old ( n = 136). Short term surgical outcomes and clinicopathological features were compared using appropriate parametric and non-parametric testing. For part two, patient’s over 85 years old were divided into two groups based upon operative technique: Laparoscopic ( n = 37) vs open ( n = 11) colorectal resection. Short-term post-operative outcomes of each approach were assessed. RESULTS The median length of stay between patients over 85 and those aged 75-85 was eight days, with no statistically significant difference between the groups ( P = 0.29). No significant difference was identified between the older and younger groups with regards to severity of complications ( P = 0.93), American Society of Anaesthesiologists grading ( P = 0.43) or 30-d mortality (2% vs 2%, P = 0.96). Patients over 85 who underwent laparoscopic colorectal resection were compared to those who underwent an open resection. The median length of stay between the groups was similar (8 vs 9 d respectively) with no significant difference in length of stay ( P = 0.18). There was no significant difference in 30-d mortality rates (0% vs 9%, P = 0.063) or severity of complication grades ( P = 0.46) between the laparoscopic and open surgical groups. CONCLUSION No significant short term surgical differences were identified in patients ≥ 85 years old when compared to those 75-85 years old. There is no difference in short term surgical outcomes between laparoscopic or open colorectal resections in patients over 85.

Practical considerations for colorectal cancer screening in older adults

“…While older studies have found that older patients have worse CRC surgical outcomes and survival than their younger counterparts[ 59 ], recent studies have shown otherwise[ 60 - 67 ]. Improvements in perioperative care, surgical techniques and the introduction of multimodal treatments have made surgery feasible for the majority of patients, including many older cancer patients[ 26 ].…”

“…These have supported that minimally invasive surgery in older CRC patients reduces overall mortality and morbidity when compared to a laparotomy, and correlates with shorter hospital stays and faster functional recovery. Furthermore, it has been clearly demonstrated that postoperative outcomes in advanced age do not significantly differ from those of younger CRC patients[ 60 - 67 ]. One study found that intraoperative and postoperative complications were equally distributed among CRC patients over 75 years of age and younger patients[ 60 ].…”

“…Additionally, Flynn et al performed a single institution, retrospective cohort study of patients who underwent resection of CRC from 2010-2018 and concluded that resection of CRC in patients over the age of 85 is safe and effective and that age alone is not a sufficient reason to withhold surgical treatment in this patient cohort[ 67 ]. The study also found that both the short-term post-operative outcomes as well as 30-d mortality was similar among patients who received open surgery versus laparoscopic intervention.…”

Changing trends in gastric and colorectal cancer among surgical patients over 85 years old: A multicenter retrospective study, 2001–2021

“…The standard operability of each case was determined according to the Japanese guidelines for the treatment of stomach[ 12 - 14 ] and colorectal cancer[ 15 - 18 ]. Based on the clinical period and location of the cancer, each institution selects the appropriate surgical procedure and determines the scope of resection, including possible lymph node resection.…”

NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study

“…In recent years, the number of elderly patients admitted to hospital for surgery has increased. This is particularly reported in colorectal surgery; indeed, the prevalence of 2 of 13 colorectal cancer (CRC) is rising among older adults [1]. Surgical outcomes could be hampered by a poor physical status.…”