Skip to main content

Advertisement

SpringerLink
Log in

Curative colorectal resections in patients aged 80 years and older: clinical characteristics, morbidity, mortality and risk factors

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The management of colorectal cancer in the elderly presents unique challenges. The objective of this study was to determine outcomes following curative colorectal resection in patients aged 80 years and older.

Patients and methods

Study design is retrospective. Data were extracted from the university hospital database and medical records of patients aged 80 years and older operated between April 2004 and December 2009. Intervention was curative colorectal resection. Main outcome measures include postoperative morbidity, mortality and individual risk factors associated with them.

Results

Three hundred fifty-eight patients (43.8 % males, age = 84 ± 3 years) were included; 72.6 % received elective surgery. A significantly higher complication rate and 30 day, 1 year and 4 year mortality were present for emergency operations compared to elective (p < 0.001). One-year survival was 65.0 % for elective resections and 55.1 % for emergency. At 4 years of follow-up, survival was 49.2 % for the elective vs. 27.6 % for emergency. The American Society of Anesthesiologists (ASA) score is the only factor associated with the 30-day mortality at the multivariate analysis (p < 0.01), Dukes staging with overall mortality (p < 0.005), sex and mode of the operation with major complications (p < 0.05). A limitation of the study is that is retrospective.

Conclusions

The highest mortality rates following colorectal surgery in the elderly are in the early postoperative period, especially for emergency operations and patients with significant comorbidities. However, the 1-year survival following elective curative resection for colorectal cancer approaches 65 %. ASA score and modality of the operation (elective vs. emergency) impacted on postoperative mortality and morbidity and could be used to select patients with more favourable outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Center MM, Jemal A, Ward E (2009) International trends in colorectal cancer incidence rates. Cancer Epidemiol Biomarkers Prev 18(6):1688–1694

    Google Scholar 

  2. Cress RD, Morris C, Ellison GL, Goodman MT (2006) Secular changes in colorectal cancer incidence by subsite, stage, stage at diagnosis, and race/ethnicity, 1992–2001. Cancer 107:1142–1152

    Article  PubMed  Google Scholar 

  3. Parkin DM, Tappenden P, Olsen AH, Patnick J, Sasieni P (2008) Predicting the impact of the screening programme for colorectal cancer in the UK. J Med Screen 15:163–174

    Google Scholar 

  4. Anonymous (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group. Lancet 356:968–974

    Google Scholar 

  5. Al-Refaie WB, Parsons HM, Habermann EB, Kwaan M, Spencer MP, Henderson WG, Rothenberger DA (2011) Operative outcomes beyond 30-day mortality: colorectal cancer surgery in oldest old. Ann Surg 253:947–952

    Article  PubMed  Google Scholar 

  6. Waldron RP, Donovan IA, Drumm J, Mottram SN, Tedman S (1986) Emergency presentation and mortality from colorectal cancer in the elderly. Br J Surg 73:214–216

    Article  PubMed  CAS  Google Scholar 

  7. Irvin TT (1988) Prognosis of colorectal cancer in the elderly. Br J Surg 75:419–421

    Article  PubMed  CAS  Google Scholar 

  8. Isbister WH (1997) Colorectal surgery in the elderly: an audit of surgery in octogenarians. Aust N Z J Surg 67:557–561

    Article  PubMed  CAS  Google Scholar 

  9. Lindmark G, Pahlman L, Enblad P, Glimelius B (1988) Surgery for colorectal cancer in elderly patients. Acta Chir Scand 154:59–63

    Google Scholar 

  10. Basili G, Lorenzetti L, Biondi G, Preziuso E, Angrisano C, Carnesecc RE, Goletti O (2008) Colorectal cancer in the elderly. Is there a role for safe and curative surgery? ANZ J Surg 78:466–470

    Article  PubMed  Google Scholar 

  11. Kesisoglou I, Pliakos I, Sapalidis K, Deligiannidis N, Papavramidis S (2010) Emergency treatment of complicated colorectal cancer in the elderly. Should surgical procedure be influenced by the factor ‘age’? Eur J Cancer Care 19:820–826

    Article  CAS  Google Scholar 

  12. Kwok AC, Lipsitz SR, Bader AM, Gawande AA (2011) Are targeted preoperative risk prediction tools more powerful? A test of models for emergency colon surgery in the very elderly. J Am Coll Surg 213(2):220–225

    Article  PubMed  Google Scholar 

  13. Violi V, Pietra N, Grattarola M, Sarli L, Choua O, Roncoroni L, Peracchia A (1998) Curative surgery for colorectal cancer: long-term results and life expectancy in the elderly. Dis Colon Rectum 41:291–298

    Article  PubMed  CAS  Google Scholar 

  14. Arenal JJ, Bengoechea-Beeby M (2003) Mortality associated with emergency abdominal surgery in the elderly. Can J Surg 46:111–116

    PubMed  Google Scholar 

  15. Uraoka T, Higashi R, Kato J, Kaji E, Suzuki H, Ishikawa S, Akita M, Hirakawa T, Saito S, Hori K, Kawahara Y, Mead RJ, Yamamoto K (2011) Colorectal endoscopic submucosal dissection for elderly patients at least 80 years of age. Surg Endosc 25(9):3000–3007

    Article  PubMed  Google Scholar 

  16. Lee SH, Lakhtaria P, Canedo J, Lee YS, Wexner SD (2011) Outcome of laparoscopic rectopexy versus perineal rectosigmoidectomy for full-thickness rectal prolapse in elderly patients. Surg Endosc 25(8):2699–2702

    Article  PubMed  Google Scholar 

  17. Wong SK, Jalaludin BB, Morgan MJ, Berthelsen AS, Morgan A, Gatenby AH, Fulham SB (2008) Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum 51:223–230

    Article  PubMed  Google Scholar 

  18. Dekker JW, van den Broek CB, Bastiaannet E, van de Geest LG, Tollenaar RA, Liefers GJ (2011) Importance of the first postoperative year in the prognosis of elderly colorectal cancer patients. Ann Surg Oncol 18:1533–1539

    Article  PubMed  CAS  Google Scholar 

  19. Tan KY, Tan P, Tan L (2011) A collaborative transdisciplinary "geriatric surgery service" ensures consistent successful outcomes in elderly colorectal surgery patients. World J Surg 35(7):1608–1614

    Article  PubMed  Google Scholar 

  20. Spivak H, Maele DV, Friedman I, Nussbaum M (1996) Colorectal surgery in octogenarians. J Am Coll Surg 183:46–50

    PubMed  CAS  Google Scholar 

  21. Morris EJ, Taylor EF, Thomas JD, Quirke P, Finan PJ, Coleman MP, Rachet B, Forman D (2011) Thirty-day postoperative mortality after colorectal cancer surgery in England. Gut 60:806–813

    Article  PubMed  Google Scholar 

  22. Leong QM, Aung MO, Ho CK, Sim R (2009) Emergency colorectal resections in Asian octogenarians: factors impacting surgical outcome. Surg Today 39:575–579

    Article  PubMed  Google Scholar 

  23. Rubinfeld I, Thomas C, Berry S, Murthy R, Obeid N, Azuh O, Jordan J, Patton JH (2009) Octogenarian abdominal surgical emergencies: not so grim a problem with the acute care surgery model? J Trauma 67:983–989

    Article  PubMed  Google Scholar 

  24. Devon KM, Urbach DR, McLeod RS (2011) Postoperative disposition and health services use in elderly patients undergoing colorectal cancer surgery: a population-based study. Surgery 149:705–712

    Article  PubMed  Google Scholar 

  25. Yang Z, Wang L, Kang L, Xiang J, Peng J, Cui J, Huang Y, Wang J (2011) Clinicopathologic characteristics and outcomes of patients with obstructive colorectal cancer. J Gastrointest Surg 15:1213–1222

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester, LE5 4PW, UK

    Ugochukwu Ihedioha, Geraint Lloyd, Sam Sangal, Baljit Singh & Sanjay Chaudhri

  2. Department of Colorectal Surgery, Pilgrim Hospital, Boston, Lincolnshire, UK

    Gianpiero Gravante

  3. Department of Human Physiology, Laboratory of Biometry, University of Tor Vergata, Rome, Italy

    Roberto Sorge

Authors
  1. Ugochukwu Ihedioha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gianpiero Gravante
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Geraint Lloyd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sam Sangal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Sorge
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Baljit Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sanjay Chaudhri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ugochukwu Ihedioha.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ihedioha, U., Gravante, G., Lloyd, G. et al. Curative colorectal resections in patients aged 80 years and older: clinical characteristics, morbidity, mortality and risk factors. Int J Colorectal Dis 28, 941–947 (2013). https://doi.org/10.1007/s00384-012-1626-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-012-1626-0

Keywords

Search

Navigation