Radical resection safe for older patients with colorectal cancer

1. In a Chinese cohort of colorectal cancer (CRC) patients over 80 years old, radical resection was found to be safe and feasible.

2. BMI and N stage are independent prognostic factors for cancer-specific survival (CSS) post radical resection.

Evidence Rating Level: 2 (Good)

The number of elderly patients receiving surgery for colorectal cancer (CRC) are increasing, due to overall increased life expectancy from improved living standards. However, medical comorbidities in the elderly population may affect surgical complication rates. Since guidelines do not recommend adjuvant chemotherapy and radiotherapy for CRC patients over 80 years, this study investigated the safety and feasibility of radical CRC surgery for patients over 80, as well as their prognosis without adjuvant treatment. The study population consisted of CRC patients from 3 medical centres in China, with pathologic confirmation of CRC and no metastasis. Surgery was done open or laparoscopic. The outcome measured was the 3-year cancer-specific survival (CSS) rate, defined as the time period between the surgery and death from cancer. In total, there were 372 patients included in the study. The mean (SD) operation time was 152.3 (58.1) minutes, the intraoperative blood loss was 67.6 (35.4) mL, the postoperative hospital stay was 11.0 (5.6) days, and the perioperative mortality rate was 0.2% (1 patient). The postop complication rate was 28.2%, with 13.5% for Grade 1-2 complications and 14.7% for Grade 3-4 complications. Common complications included abdominal abscess (5.4%), ileus (4.6%), and anastomotic leak (4.6%). Over a mean follow-up of 60 months, there was a total mortality of 34.9% and mortality from tumour recurrence or metastasis was 27.4%. Factors that significantly and independently affected CSS include BMI (hazards ratio 2.30, 95% CI 1.27-4.17, p = 0.006) and N stage (HR 2.97, 95% CI 1.48-5.97, p = 0.002). Overall, this study demonstrated the safety and feasibility of radical CRC surgery for patients over 80 years, with BMI and N stage being independent factors that influence CSS.

Click to read the study in BMC Surgery

Image: PD

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