Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2021; 13(3): 185-196
Published online Mar 15, 2021. doi: 10.4251/wjgo.v13.i3.185
Should we resect colorectal cancer in patients over the age of 85?
David E Flynn, Derek Mao, Stephanie Yerkovich, Robert Franz, Harish Iswariah, Andrew Hughes, Ian Shaw, Diana Tam, Manju Chandrasegaram
David E Flynn, Department of General Surgery, The Prince Charles Hospital, Chermside 4032, Queensland, Australia
Derek Mao, Robert Franz, Harish Iswariah, Andrew Hughes, Ian Shaw, Diana Tam, Manju Chandrasegaram, Department of General Surgery, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
Stephanie Yerkovich, The Common Good Foundation, The Prince Charles Hospital, Brisbane 4032, Queensland, Australia
Author contributions: Flynn DE designed the study, performed the research and wrote the manuscript; Mao D designed the study methodology and helped perform the research; Yerkovich S helped with data collection, statistical analysis and manuscript review; Franz R, Iswariah H, Hughes A, Shaw I and Tam D helped with data collection, clinical advice, data analysis and manuscript review; Chandrasegaram M helped with design methodology and conceptualisation, study supervision, manuscript editing and finalisation.
Institutional review board statement: Ethics approval for this database was granted by the Prince Charles Hospital Human Research Ethics Committee (Approval No. HREC/17/QPCH/295).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that was obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None of the authors have any conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: David E Flynn, BSc, MD, MS, Doctor, Department of General Surgery, The Prince Charles Hospital, Rode Road, Chermside 4032, Queensland, Australia. deflynn75@gmail.com
Received: December 1, 2020
Peer-review started: December 1, 2020
First decision: December 20, 2020
Revised: December 31, 2020
Accepted: January 28, 2021
Article in press: January 28, 2021
Published online: March 15, 2021
Processing time: 97 Days and 20.8 Hours
Abstract
BACKGROUND

The prevalence of colorectal cancer in the elderly is rising, with increasing numbers of older patients undergoing surgery. However, there is a paucity of information on the surgical outcomes and operative techniques used in this population.

AIM

To evaluate the post-operative outcomes for patients ≥ 85 years old following colorectal cancer resection as well as evaluating the outcomes of laparoscopic resection of colorectal cancer in patients over 85.

METHODS

Patients who underwent colorectal cancer resection at our institution between January 2010 and December 2018 were included. The study was divided into two parts. For part one, patients were divided into two groups based on age: Those age ≥ 85 years old (n = 48) and those aged 75-84 years old (n = 136). Short term surgical outcomes and clinicopathological features were compared using appropriate parametric and non-parametric testing. For part two, patient’s over 85 years old were divided into two groups based upon operative technique: Laparoscopic (n = 37) vs open (n = 11) colorectal resection. Short-term post-operative outcomes of each approach were assessed.

RESULTS

The median length of stay between patients over 85 and those aged 75-85 was eight days, with no statistically significant difference between the groups (P = 0.29). No significant difference was identified between the older and younger groups with regards to severity of complications (P = 0.93), American Society of Anaesthesiologists grading (P = 0.43) or 30-d mortality (2% vs 2%, P = 0.96). Patients over 85 who underwent laparoscopic colorectal resection were compared to those who underwent an open resection. The median length of stay between the groups was similar (8 vs 9 d respectively) with no significant difference in length of stay (P = 0.18). There was no significant difference in 30-d mortality rates (0% vs 9%, P = 0.063) or severity of complication grades (P = 0.46) between the laparoscopic and open surgical groups.

CONCLUSION

No significant short term surgical differences were identified in patients ≥ 85 years old when compared to those 75-85 years old. There is no difference in short term surgical outcomes between laparoscopic or open colorectal resections in patients over 85.

Keywords: Aged; Colorectal neoplasms; General surgery; Open abdomen techniques; Laparoscopy; Colorectal surgery

Core Tip: This is a retrospective study to assess the outcomes of patients over 85 undergoing colorectal cancer resection. Patients over the age of 85 who underwent surgery were found to have equitable short term surgical outcomes when compared to those aged 75-85 years old. There was no difference in length of stay, severity of complications or mortality rates between the two groups. Patients over 85 were also analyzed based upon outcomes following open or laparoscopic surgery. There were no significant differences between length of stay, complication rates or mortality rates between the two techniques. Surgical intervention for colorectal cancer should not be based upon age alone.