engleski

Colorectal cancer in the elderly

INTRODUCTION. The incidence of the majority of solid-organ malignancies rises with increasing age, including colorectal cancer. Increasing age is usually accompanied by worsening overall medical health due to the accumulation of co-morbid conditions and those elderly patients undergoing surgical treatment for colorectal cancer had higher ASA classification. While some studies demonstrate that age is not an independent risk factor for operative complications, others reported that age greater than 70 years was one of only four factors predictive of postoperative mortality. Patients over 65 years of age more often have comorbid diseases, present in later stages of the disease and more often require urgent surgery than younger patients. Our goal was to determine the outcome of surgical treatment for colorectal carcinoma in elderly patients in our hospital.PATIENTS AND METHODS. We retrospectively analysed patients operated for colon cancer in the period from 1.1.2000. to 31.12.2005. From their medical documentation, we recorded their age, sex, cancer localization, type of operation, Dukes classification of the cancer and postoperative morbidity and mortality. We then divided the patients in two groups - patients with 70 years or more (older group) and patients with less than 70 years (younger group). These two groups were compared in respect to all recorded parameters. Statistical analysis was done using Chi-square test. RESULTS In the period from 1.1.2000. to 31.12.2005. at the Clinical Hospital Dubrava, 642 patients were operated for colorectal carcinoma. Older group consisted of 389 patients (61%), and younger group consisted of 253 patients (59%). There were no differences between the groups concerning sex distribution. Compared with the younger patients, the elderly had a higher incidence of comorbid medical diseases (54% and 36%, respectively). Older group had more advanced colon cancers according to Dukes classification (p<0, 01), with the largest difference in stage D (26% of cases in older group, 8% in younger group). According to this, palliative procedures were more frequently performed in the older group (21% of the cases) than in the younger group (17% of the cases). Also, older group had higher postoperative anastomosis leakage and wound infection rates (7% and 12%, respectively) than younger group (4% and 9%, respectively). There was no difference between the elderly patients and younger patients concerning early postoperative mortality. DISCUSSION. In this study, we demonstrated that elderly patients have more advanced colon cancers than the patients younger than 70 years.Consequently, palliative operations were more frequent in the older group. Even though postoperative anastomosis leakage and wound infection rates were higher in the older group, our groups did not differ in overall postoperative morbidity or early postoperative mortality rates. Our conclusion is that, compared to younger patients, elderly patients are not at higher risk of postoperative complications after colon cancer resection. The indications for surgical resection for colorectal cancer in patients aged 75 years and older should therefore be the same as those for younger patients.

colorectal cancer

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