Impact of octogenarians on surgical outcome in colorectal cancer

• Influence of age (≥80) on treatment and surgical outcome of colorectal cancer.
• Comparing two groups: younger than 80 years vs older.
• Advanced age is an independent predictor factor of 30-days mortality and morbidity, instead it is not predictive of 90-days mortality.
• In elective colorectal surgery, octogenarian age is not a predictive factor of post-operative 30-and 90-day mortality.
• Old age as such doesn't represent a contraindication for surgical treatment but it's associated with an increased risk of postoperative morbidity and mortality in emergency procedures.

AimColorectal cancer's (CRC) incidence occupies the second place among malignant tumours in men and the third place in women. The aging of the population raises new questions on the management of CRC in octogenarian patients. The objective of this study was to assess the influence of age (≥80) on treatment and surgical outcome of colorectal cancer.MethodIn the period between October 1995 and April 2014, a total of 1397 patients underwent emergency and elective surgical interventions for CRC; the first group (Group-Older – GO) was composed of 291 patients 80 years or older (20.9%, of which 46.4% were male). The second group (Group-Younger – GY) included 1106 patients younger than 80 years (79,1%, 57.7% males).ResultsSignificant differences between the two groups were observed regarding sex (p = 0.001), number of comorbidities (p = 0.001), ASA classification (p < 0.001), emergency presentation (p < 0.001), site of tumor (p = 0.010), need of intraoperative blood transfusions (p < 0.001), 30-days mortality (p < 0.001), 90-days mortality (p < 0.001) and morbidity in accordance with Clavien-Dindo classification (p < 0.001). When combining both elective and emergency procedures, multivariate logistic regression analysis showed that advanced age (≥80 years old) was an independent predictor factor of 30-days mortality (p = 0.023, OR = 2.23) and morbidity (p = 0.088, OR = 1.31), while it was not predictive of 90-days mortality. When considering only elective colorectal surgery, octogenarian age was not found to be a predictive factor of 30-day and 90-day mortality, but predictive of postoperative morbidity.ConclusionOld age (≥80) does not represent a contraindication to CRC elective surgical treatment, in emergency procedures it is associated with an increased risk of postoperative morbidity and mortality.