Surgical treatment of colon cancer in patients older than age 80.

Abstract

6071 Background: Individuals >80 years represent a growing proportion of colon cancer patients and create a decision-making challenge for surgeons due to frequent comorbidities. Our objective was to describe patterns of surgery in colon cancer patients >80 years and examine outcomes with and without colectomy. Methods: Medicare beneficiaries >80 years with colon cancer diagnosed from 1992-2005 were identified from the Surveillance, Epidemiology, and End Results-Medicare database; stage IV was excluded. χ2 and two-way ANOVA assessed differences in patient characteristics. Kaplan-Meier survival analysis determined one-year overall and disease-specific survival. Results: Of 35,080 patients, 80% underwent colectomy within 90 days of diagnosis. 46% were for urgent/emergent reasons. Post-operative complications occurred in 4%, and 9% died within 30 days. Patients not selected for colectomy had more comorbidities (higher HCC risk score), were more likely to have a wheelchair and use home oxygen (Table). 11% of these non-operative patients ultimately required a cancer-related intervention (delayed colectomy 9%, stoma 1.4%, stent 0.4%). One-year overall survival with and without colectomy was 77 vs. 58%. One-year disease-specific survival was 89 vs. 76%. Conclusions: Most older colon cancer patients undergo colectomy, although many for urgent/emergent reasons. Disease-specific survival after colectomy is greater than overall survival, confirming that many die due to competing causes. Further research should focus on improving mechanisms to identify those patients >80 years at increased risk for a poor outcome after elective colectomy. Colectomy(n=28,070) No colectomy(n=7,010) P value Age at diagnosis* 85.0 (4.2) 85.9 (4.6) <0.0001 Male gender 37% 39% <0.001 HCC risk score** 2.32 (1.5) 2.58 (1.8) <0.0001 Mobility No device 91.7% 87.6% <0.001 Crutch, cane, or walker 4.6% 5.9% Wheelchair 3.7% 6.6% Home oxygen use 2.3% 3.8% <0.001 No. of hospitalizations in year prior to diagnosis* 1.49 (0.90) 1.70 (1.16) 0.010 Surgical evaluation after diagnosis 61% 46% <0.001 SEER historic stage Local 46.6% 47.4% <0.001 Regional 52.1% 23.3% Unstaged 1.2% 29.3% Abbreviation: HCC, hierarchical condition categories (measure of comorbidity). * Mean, standard deviation.