Surgery for large bowel cancer in people aged 75 years and older

Payne, John E.; Chapuis, Pierre; Pheils, Murray T.

doi:10.1007/bf02555321

Cited by 98 publications

(49 citation statements)

References 17 publications

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“…While the numerical difference is large, both data is insignificant at p=0.071 and p=0.392 respectively. This finding contradicts previous literature, whereby age has inevitably been identified as a risk factor for longer LOS and in needing higher postoperative care (13)(14)(15). However, caution must be exercised in the analysis of this data as the small study sample size could be limiting the analysis.…”

Section: Discussioncontrasting

confidence: 55%

“…Overall, there were no difference of tumour staging in the elderly cohort, a finding which seems to be equivocal in current literature (15)(16)(17)(18)22,25) Cost effectiveness of CRC surgery in the elderly patients has been a rising topic for discussion. Govaert et al recently showed that hospital cost of CRC surgery is actually lower in patients aged ≥85, with the major driver of lower cost related to ward and ICU cost (26).…”

Section: Discussionmentioning

confidence: 73%

See 1 more Smart Citation

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Yen

Simillis

Choudhry

et al. 2017

Acta Chirurgica Belgica

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 73%

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Yen

Simillis

Choudhry

et al. 2017

Acta Chirurgica Belgica

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“…The gap that has separated younger from elderly patients is closing. Although there have been recent reports from hospital series to the same effect (Bader, 1986;Kirtland and Hobler, 1986;Payne et al, 1986;Waldron et al, 1986;Irvin, 1988;Lewis and Khoury, 1988;Fielding et al, 1989;Ozoux et al, 1990;Arnaud et al, 1991), often indicating more optimistic figures (Brown et al, 1988), these reports are limited by unavoidable selection bias, especially for elderly patients. A community-based cancer registry has the advantage of providing a non-biased and detailed view of time trends in the management of cancer, without the limitations due to recruitment, which often varies with time.…”

Section: Discussionmentioning

confidence: 99%

Colon cancer in the elderly: evidence for major improvements in health care and survival

Arveux

Boutron²,

Mrini³

et al. 1997

Br J Cancer

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Summary Time trends in therapeutic approaches and in the prognosis of colon cancer for patients aged 75 years and above have been investigated in comparison with corresponding trends for younger patients using a population-based series of 2089 colon cancer patients diagnosed between 1976 and 1990 in the C6te-d'Or area (478 000 inhabitants), Burgundy, France. Significant progress has been achieved in the management of patients with colon cancer in both age groups, but trends have been more noticeable in patients aged 75 years and above. In the elderly, the proportion of cancers limited to the digestive tract wall showed a 3-year average increase of 2.8% (P = 0.02) and the frequency of curative surgery an average increase of 8.6% (P < 0.001), so that it was performed in 80% of cases in the last 3-year period. Operative mortality decreased by 2.5% between 3-year periods (P < 0.004). Crude 5-year survival rates in elderly patients increased from 15% in the 1976-78 period to 29% in the 1985-87 period (P < 0.001), the corresponding figures being 36% and 44% (P > 0.10) in younger patients.Keywords: colon cancer; stage at diagnosis; time trends; survival Colon cancer is a major problem in elderly patients. Incidence rates rise with age, and over 40% of cases occur in subjects over the age of 74. Recent studies have demonstrated an increase in the incidence of colon cancer in several areas of the Western world (Coleman et al, 1993) and, given the increasing life expectancy of Western populations, an ever-growing number of aged people is exposed to the risk of colon cancer. Age has often been considered as a negative factor in the prognosis for this cancer. However, raw survival data, from which such conclusions are usually drawn, overestimate mortality due to the malignancy under investigation, especially in elderly patients, for whom mortality owing to other causes is high, and tend to conceal the progress that has been achieved in the perioperative management of elderly patients over the past 15 years (Pillon et al, 1991). Data on therapeutic approaches and on the prognosis of colon cancer patients have mostly been provided by specialized hospital units, with unavoidable selection bias, especially for elderly patients. Outcome measuresThe spread of each malignancy at the time of diagnosis was classified, for resected cancers, according to Dukes (1932), as: limited to the digestive wall (Dukes A) (I, see tables); extension beyond the digestive wall (Dukes B) (II); and lymph node involvement (Dukes C) (Ill). In the absence of resection, cancers were classified as either metastatic (IV) or of undetermined stage (i.e. absence of detectable metastasis) (V). Treatment procedures were defined as: surgery for cure, i.e. complete tumour removal with tumour-free margins (1); palliative resection (II); palliative surgery with no tumour resection (i.e. colostomy or explorative laparotomy) (III); and medical treatment without surgery, i.e. chemotherapy, radiotherapy or purely palliative treatment (IV). As the impact of age and oth...

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“…The 5-year survival rate of elderly colorec tal cancer patients has been reported to be somewhat poorer than that of younger pa tients, the figures ranging between a 20 to 30% reduction [9][10][11][12], It has been found that mortality and survival rates in 75-to 80-yearold patients are at least equal to those of youn ger patients. However, patients aged 80 and over more often have cancers with associated complications, a higher operative mortality, and a poorer prognosis [12][13][14],…”

Section: Introductionmentioning

confidence: 93%

Influence of Age on Colorectal Cancer’s 5-Year Survival

Kemppainen

Räihä²,

Sourander³

1995

Gerontology

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The aim of this study was to ascertainthe 5-year survival figures of 171 consecutive colorectal cancer patients in southwestern Finland, the differences between various age groups, and which clinical variables predict poor outcome. The mean age at the time of diagnosis was 67 years in men and 69 years in women. The 5-year survival was lower in older patients, especially in those over 80 years with concomitant diseases. However, the colorectal cancer mortality did not differ between the three age groups: < 65, 65–80, > 80 years. Employing univariate analysis, a poor 5-year outcome was associated with metastases, and the outcome was excellent if the cancer was confined locally (p = 0.0001). As many as 26% of the patients in whom the cancer was confined to the bowel wall (Dukes B) at the time of operation died within 5 years. A poor survival rate was also found if the patients had emergency operations (p = 0.0021). The postoperative mortality was 6%. Using logistic regression analysis, the poor 5-year survival rate was correlated strongly with metastasized cancer (p = 0.000) but less so with age (p = 0.040).

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Surgery for large bowel cancer in people aged 75 years and older

Cited by 98 publications

References 17 publications

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

A comparative study of short-term outcomes of colorectal cancer surgery in the elderly population

Colon cancer in the elderly: evidence for major improvements in health care and survival

Influence of Age on Colorectal Cancer’s 5-Year Survival

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