Ker-kan Tan, FRCS Edin, Frederick H Koh, MBBS, Yan-yuan Tan, MBBS, Jody Z Liu, MRCS Edin, Richard Sim, FRCS. Tan Tock Seng Hospital
The incidence of colorectal cancer in elderly patients is likely to increase with an aging population. The aims of this study are to review our experience in the surgical management of octogenarians with colorectal cancers and to identify factors that influence the short- and long-term outcomes.
A retrospective review of all octogenarians who underwent surgery for colorectal cancer from December 2002 to October 2008 was performed.
We identified 204 patients with a median age 84 (range, 80 – 97) years. The majority of patients had an ASA score ≥ 3 (n = 142, 69.6%) and a Charlson Comorbidity Index of ≤ 3 (n = 128, 62.7%). Emergency surgery was performed in 83 (40.7%) patients. Left sided malignancy was seen in 138 patients (67.6%).
Most of the patients had either stage II (n = 75, 36.8%) or III (n = 69, 33.8%) diseases. The 30-day mortality rate was 16.2% (n = 33). Factors associated with mortality included emergency surgery and renal impairment. After multivariate analysis, the independent variables predicting worse peri-operative complications were age > 85 years old and Charlson Comorbidity Index > 3.
The median follow up for the 171 remaining patients was 27 (2 – 92) months. Thirty-one (21.2%) of 146 patients who survived curative surgery developed recurrent disease. Seventy (34.3%) patients died from various aetiologies (60% cancer specific and 40% non-cancer mortality). Disease free and overall survivals were both adversely affected in patients with advanced malignancy and in those with severe peri-operative complications.
Surgery for octogenarians with colorectal cancers is associated with significant morbidity and mortality rates. Some of the factors predicting worse peri-operative outcomes included emergency surgery, increasing age and Charlson Comorbidity Index > 3. Long term survival is dependent on the stage of the malignancy and the presence of severe peri-operative complications.
Session Number: Poster – Poster Presentations
Program Number: P130