Role of surgery for colorectal cancer in the elderly

Table 1 Postoperative mortality, resection rates, comorbidities, survival rate and independent prognostic factors reported in different studies on colorectal surgery in the elderly

Ref.	Year	No. of patients	Postoperative mortality	Resection rates	Comorbidities	Survival rate	Independent prognostic factors
Damhuis et al[9]	1996	6457	1% for patients < 60 yr and steadily increased with age. The operative risk was 10% for patients > 80 yr	87% of the patients underwent resection. 67% for patients > 89 yr and 83% for patients with rectal cancer	-	-	Gender, age, subsite and stage
Damhuis et al[11]	2005	2765	Increased from 8% for the age group 80-84 to 13% for those 85-89 to 20% in nonagenarian	-	-	-	-
Hermans et al[17]	2010	207	In-hospital mortality was 16% in the elderly and 5% in the younger group (P < 0.01)	No differences between < 75 yr and > 75 yr; ileocecal resection (2% vs 4%); hemicolectomy right (42% vs 49%); transversum resection (1% vs 3%); hemicolectomy left (15% vs 8%); sigmoid resection (26% vs 22%); anterior resection (10% vs 9%); subtotal colectomy (3% vs 1%); double resection (1% vs 4%)	More co-morbidities > 75 yr, especially cardiovascular pathology (P < 0.01) and dementia (P < 0.01). more than one type of comorbidity according to the Charlson classification (P < 0.05)	5-yr survival rate in < 75 yr was 62% compared with 36% in the elderly (P < 0.05)	-
Neuman et al[21]	2013	31574	30-d mortality rate of 10% after urgent/emergent admission	-	Hypertension, peripheral vascular disease, and chronic pulmonary disease were found to be associated with improved overall and cancer-specific survival	The 1-yr overall survival rate was lower than the colon cancer-specific survival rate (operative patients: 78% vs 89%; non-operative patients: 56% vs 76%	Older age, black race, more hospital admissions, use of home oxygen, use of a wheelchair, being frail, and having dementia
Irvin[23]	1988	306	The surgical mortality rates for patients > 70 yr were 6% overall, 4% after elective operations, and 16% after emergency surgery; the corresponding mortality rates for patients < 70 yr were 3%, 1%, and 20%	-	-	Crude actuarial 5-yr survival curves showed an increased death rate for patients > 70 yr after 18 mo and a significantly lower 5-yr survival (P < 0.05) but the age-corrected survival curves for the two groups were not significantly different	-
Temple et al[34]	2004	9011	The 30-d postoperative mortality was 10%. The 30-d surgical mortality was significantly greater in the no primary cancer-directed surgery (CDS) group among patients who underwent a surgical procedure, when compared with the primary CDS group (26% vs 9%, P = 0.001)	The rates of CDS declined with age: 76% of 65 to 69-yr-old patients received primary CDS, whereas the rate declined to 62% of patients age ≥ 85 yr	-	The overall median survival for the entire cohort was 7 mo. There were differences in survival between patients treated with CDS and no CDS exist (median, 10 mo vs 3 mo, respectively), but data are not reliably because of patient selection in the non-randomized setting	Left-sided or rectal lesions, age > 75 yr, blacks, marital status and lower socioeconomic status
Vallribera Valls et al[42]	2014	277: Laparoscopic group; 268: Open group	Open surgery group showed a higher mortality (6.7% vs 3.2%, P = 0.034). Mortality was significantly inferior in laparoscopy group in younger patients (< 75 yr, 0% vs 3%, P = 0.038)	-	Open surgery group showed a higher overall morbidity rate (37.3 vs 21.6%, P = 0.001), medical complications (16.4% vs 10.5%, P = 0.033), surgical complications (23.5% vs 15.5%, P = 0.034), the	-	-
					overall morbidity rate difference between open and laparoscopy approach disappeared in the oldest group (≥ 85 yrs old). Surgical site infections rate was inferior for patients < 75 yr old in laparoscopy group compared with open
Vignali et al[45]	2005	61: Laparoscopic colectomy; 61: Open colectomy	Overall mortality rate was 2.4%. The morbidity rate was 21.5% in the laparoscopy group and 31.1% in the open group (P = 0.30)	-	-	-	-
Bouvier et al[49]	2005	1571 with colon cancer; 838 with rectal cancer	During the study period from 8.7% to 9.5% for colon and from 16.3% to 5.6% for rectum	69% in colon cancer; 54% in rectal cancer	-	Overall 3-yr survival rates were 45.2% for colon cancer and 46.2% for rectal cancer. Overall 5-yr survival rates were 40.9% and 37.3% respectively	Age, gender, period of diagnosis, treatment. A second multivariate analysis restricted to patients resected for cure and alive after the first month of follow-up showed that age between 85 and 89 was no longer a significant factor of survival
Heald et al[50]	1998	519 with rectal cancer	The operative mortality (30-d) was 3.3%	-	-	68% at 5 yr and 66% at 10 yr	-
Kim et al[51]	2016	62 with very low rectal cancer. Group I, n = 24, stage T2 Group II, n = 38, stage T3	No postoperative mortality in both groups	-	Temporary urinary retention (group I: 10 cases; Group II: 15 cases), postoperative paralytic ileus (group I: 2 cases; Group II: 3 cases), perineal abscess (group I: 1 case; Group II: 1 case), and anastomotic leakage (group I: 1 case; Group II: 1 case). Late complications, such as anastomotic stricture (group I: 6 cases; Group II: 10 cases), rectovaginal fistula (group I: 0 case; Group II: 1 case) after stoma closure	5-yr overall survival rates were 95.8% for group I and 94.7% for group II. The 5-yr recurrence-free survival rates were 87.5% for group I and 86.8% for group II	-
Schiffmann et al[54]	2008	517	30-d mortality was higher in the older age group (> 75 yr)	-	No differences in 30-d morbidity except in postoperative bleeding	-	-
Devon et al[55]	2009	898	The in-hospital mortality rate was 1% in the younger group (< 75 yr) compared with 4.2% in the older (> 75 yr) (P = 0.002)	-	-	The overall five-year survival was 68.7% and 57.3% in the younger and older groups, respectively, whereas colorectal cancer-specific five-year survival was not significantly different (74.0% vs 74.7%)	-
Paksoy et al[56]	1999	822	The postoperative (30 d) mortality was 3% in the younger group (< 65 yr) (20/565) and 7% in the older group (17/257) (difference not significant)	-	-	Five-year survival rates for older and younger patients were 33% and 45%, respectively (P < 0.05)	-