Published online Mar 15, 2021. doi: 10.4251/wjgo.v13.i3.185
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
The global population is living longer than ever before. As a result of extended life expectancies, the prevalence of colorectal cancer in the elderly is increasing. There is a paucity of information on the role of colorectal cancer surgery in the elderly and the short term surgical outcomes associated with this demographic. There is also very little literature on the role of laparoscopic resection of colorectal cancer in those at the extremes of age.
This research was undertaken to determine the short-term surgical outcomes in those over 85 following colorectal cancer resection. With the increasing use of laparoscopic colorectal surgery, we also ought to investigate the viability of laparoscopic surgery in the over 85 population.
The main objectives was to determine whether patients over 85 had equitable outcomes following colorectal cancer surgery to those in a younger age bracket. We also sought to investigate the short term surgical outcomes from laparoscopic surgery vs open surgery in over 85’s. This research is important as older patients are at a high risk of having surgery withheld based upon age alone, without clear evidence demonstrating whether age is a determinant of poorer surgical outcomes. Furthermore, this research helps to indicate when open or laparoscopic surgery provides better outcomes in this age group.
Patients who underwent colorectal cancer resection between January 2010 and December 2018 at The Prince Charles Hospital, Brisbane were included in the study. The study was divided into two parts. The first part examined two groups: Those over the age of 85 and those aged 75-84. The short term surgical outcomes were compared between the two groups using parametric and non-parametric tests. The second part of the study investigated the outcomes of patients over 85 who had open surgery vs laparoscopic surgery. The short term outcomes of each approach were compared and analyzed.
Our research demonstrated that there were no significant differences between the short-term surgical outcomes in those over the age of 85 vs those aged 75-85 years old. The average length of stay between the two groups was the same at eight days. There was no significant difference in severity of post-operative complications (P = 0.93) or 30-d mortality rates (P = 0.96). For patients over 85 who underwent laparoscopic resection, there was no difference in outcomes to those that underwent open resection. Between the laparoscopic and open surgical groups there was no difference in length of stay (P = 0.18), severity of post-operative complications (P = 0.46) or 30-d mortality rates (0.06).
From our research we can conclude that it is safe and effective to surgically resect colorectal cancer in patients over the age of 85. There are no significant differences in post-operative outcomes between the over 85 group and the 75-84 years old group. This leads up to conclude that patients should not have surgery withheld based upon age alone. Furthermore, we demonstrated that laparoscopic surgery has equitable outcomes to open surgery and is a viable option in those over 85 years old.
Further studies in this area should investigate the role of frailty scores on surgery outcomes. We have demonstrated that age is no barrier to good surgical outcomes, but the role of frailty scores on post-operative outcomes and surgical candidacy could be explored further.