Abstract
The number of colorectal cancer patients increases with age. Long-term data support personalized management due to heterogeneity within the older population. This registry- and population-based study aimed to analyse long-term survival, and causes of death, after elective colon cancer surgery in the aged, focusing on patients who survived more than 3months postoperatively. The data included patients ≥80years who had elective surgery for Stage I-III colon cancer in four Finnish centres. The prospectively collected data included comorbidities, functional status, postoperative outcomes and long-term survival. Univariate and multivariate Cox regression analysis were conducted to determine factors associated with long-term survival. A total of 386 surgical patients were included, of whom 357 survived over 3months. Survival rates for all patients at 1, 3 and 5 years were 85%, 66% and 55%, compared to 92%, 71% and 59% for patients alive 3months postoperatively, respectively. Higher age, American Society of Anesthesiologists (ASA) score ≥4, Charlson Comorbidity Index≥6, tumour Stage III, open compared to laparoscopic surgery and severe postoperative complications were independently associated with reduced overall survival. Higher age (hazard ratio 1.97, 1.14-3.40), diabetes (1.56, 1.07-2.27), ASA score ≥4 (3.27, 1.53-6.99) and tumour Stage III (2.04, 1.48-2.81) were the patient-related variables affecting survival amongst those surviving more than 3months postoperatively. Median survival time for patients given adjuvant chemotherapy was 5.4years, compared to 3.3years for patients not given postoperative treatment. Fit aged colon cancer patients can achieve good long-term outcomes and survival with radical, minimally invasive surgical treatment, even with additional chemotherapy.
Highlights
Colorectal cancer is the second most diagnosed malignancy in Finland, and the third most diagnosed in the world [1,2]
American Society of Anesthesiologists (ASA) score ≥ 4, Charlson Comorbidity Index ≥ 6, tumour Stage III, open compared to laparoscopic surgery and severe postoperative complications were independently associated with reduced overall survival
Higher age, diabetes (1.56, 1.07–2.27), ASA score ≥ 4 (3.27, 1.53–6.99) and tumour Stage III (2.04, 1.48–2.81) were the patient-related variables affecting survival amongst those surviving more than 3 months postoperatively
Summary
Colorectal cancer is the second most diagnosed malignancy in Finland, and the third most diagnosed in the world [1,2]. The age-standardized incidence of colorectal cancer has globally increased 9.5%, and in Finland 17.3%, between the years 1990 and 2017. The global burden of colorectal cancer is expected to grow by 60%. Surgery is the cornerstone of treatment for colorectal cancer [4]. The increased number of older people results in more operations for colorectal cancer in this group [5]. Current studies show comparable diseasespecific long-term survival rates for all age groups,. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland
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