The influence of age on the outcome of treatment of elderly patients with colorectal cancer

ObjectivesWe investigated factors associated with post-operative mortality rates in those aged ≥ 60, and in particular, the relative survival of age bands within this group.MethodsSecondary analysis of a large comprehensive cohort of the elderly treated for colorectal cancer in the North of England during 1998–2003. We investigated seven risk factors associated with 30-day and 6-month post-operative mortality from colorectal surgery.Results6083 patients aged ≥ 60 underwent colorectal cancer surgery. Approximately 8% had died within 30 days of surgery and 17% had died within 6 months. Thirty-day mortality was greater in the elderly (80 years +) compared to the young-old (60–69 years) (adjusted OR: 3.2, 95% CI 2.4 to 4.4). There was neither a significant difference between the proportions offered curative resections across the age-groups, nor was there a significant association between intent of surgery and 30-day mortality. Six-month mortality rose with age, but the association was stronger in those having curative surgery (adjusted OR: 3.8, 95% CI 2.8 to 5.2) than palliative surgery (adjusted OR: 1.5, 95% CI 1.1 to 2.1). Mortality from emergency surgery at 6-months was particularly high in elderly females.ConclusionsThis large population study adds more weight to the findings that age itself is a major risk factor in the outcome of colorectal surgery in elderly and that 30-day mortality underestimates the longer-term outcome in this age group. There was no significant association between radical resections and 30-day mortality in elderly patients compared to the younger age groups; however, a disproportionately higher mortality at 6 months was seen in elderly female patients.