Abstract
PurposePatients aged > 80 years represent an increasing proportion of colon cancer diagnoses. Selecting patients for elective surgery is challenging because of possibly compromised health status and functional decline. The aim of this retrospective, population-based study was to identify risk factors and health measures that predict short-term mortality after elective colon cancer surgery in the aged.MethodsAll patients > 80 years operated electively for stages I–III colon cancer from 2005 to 2016 in four Finnish hospitals were included. The prospectively collected data included comorbidities, functional status, postoperative surgical and medical outcomes as well as mortality data.ResultsA total of 386 patients (mean 84.0 years, range 80–96, 56% female) were included. Male gender (46% vs 35%, p = 0.03), higher BMI (51% vs 37%, p = 0.02), diabetes mellitus (51% vs 37%, p = 0.02), coronary artery disease (52% vs 36%, p = 0.003) and rheumatic diseases (67% vs 39%, p = 0.03) were related to higher risk of complications. The severe complications were more common in patients with increased preoperative hospitalizations (31% vs 15%, p = 0.05) and who lived in nursing homes (30% vs 17%, p = 0.05). The 30-day and 1-year mortality rates were 6.0% and 15% for all the patients compared with 30% and 45% in patients with severe postoperative complications (p < 0.001). Severe postoperative complications were the only significant patient-related variable affecting 1-year mortality (OR 9.60, 95% CI 2.33–39.55, p = 0.002).ConclusionsThe ability to identify preoperatively patients at high risk of decreased survival and thus prevent severe postoperative complications could improve overall outcome of aged colon cancer patients.
Highlights
The incidence of colorectal cancer has tripled during the past five decades, and the risk of having colorectal cancer increases with age [1]
Patients were evaluated for their fitness for elective surgery with general anaesthesia but were not preselected any other way
Our material consisting of 386 patients is the largest dataset regarding elective colon cancer surgery with curative intent and focusing on both postoperative complications and short-term mortality in this age group
Summary
The incidence of colorectal cancer has tripled during the past five decades, and the risk of having colorectal cancer increases with age [1]. According to the Finnish Cancer Registry data from 2016, 27% of all colorectal patients were aged 80 years or more [1]. The number of aged people diagnosed with colorectal cancer will increase as the population ages [2]. Colon cancer is managed by radical surgical resection [3, 4]. Previous studies show comparable diseasespecific survival rates for all age groups, which advocates tumour resection with curative purpose [5, 6]. In the EUROCARE-5 study, 5-year overall survival rate was 49% for colon cancer patients of 75 years or older while overall survival rate for all ages was 57% in Europe [7].
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