Local vs radical resection of stage I-III rectal cancer in very elderly patients: an exact matched analysis of the National Cancer Database

Abstract

BackgroundTreatment of elderly cancer patients is challenging as they can be over-treated with respect to frailty or under-treated due to advanced age. Maintaining a good quality of life is essential for this population. This study aimed to assess the difference in overall survival and short-term outcomes according to extent of rectal cancer resection in patients aged ≥80 years. MethodsIn this retrospective cohort study, very elderly patients with stage I-III rectal cancer aged ≥80 years were identified from the National Cancer Database (2004-2019). Patients were divided into two groups: radical resection and local excision. The groups were matched using exact matched analysis for clinical T and N stage, tumor size, and neoadjuvant treatment. Main outcome measures were overall survival, hospital stay, 30-day unplanned readmissions, and short-term mortality. Results9634 patients were included (local excision = 2710; radical resection = 6924). After matching, 1106 patients were included in each group with a median follow-up of 49.9 and 51.7 months, respectively. The radical resection group had statistically significantly longer overall survival than did local excision (60 vs. 57.2 months, p=0.026). Local excision was associated with shorter length of stay (1 vs. 7 days. p<0.001), lower 30-day mortality (Odds ratio: 0.43; 95%CI: 0.25- 0.75, p=0.003), lower 90-day mortality (Odds ratio: 0.47, 95%CI: 0.32- 0.68, p<0.001), and lower 30-day readmission (Odds ratio: 0.49, 95%CI: 0.33- 0.74, p<0.001). A subgroup analysis of matched patients with cTis-T2, N0 tumors who underwent curative surgery, revealed similar results. ConclusionsRadical resection of rectal cancer in very elderly patients had a modest survival benefit whereas local excision had lower odds of readmission and short-term mortality.