Colorectal Cancer Surgery in Extreme Elderly Population


Background: Colorectal cancer surgery in extreme elderly population (380 years) is a growing problem and a subject in question. Experiences and results in this scenario are limited. Methods: Medical records of patients 380 years old hospitalized in General Surgery Department in Vega Baja Hospital between January 1st 2008 and December 31st 2012 were retrospectively reviewed. Patients diagnosed with colorectal cancer (CRC) were selected. Data regarding comorbidities, treatment performed, complications and survival were collected. Results: 95 patients (74 colon, 21 rectum) were identified: median age 83.0 years (80 - 93), 64.2% males. 93.7% of patients were operated on: median hospital and post-operative stay of 11 and 9 days, respectively; curative intention surgery 82.1%. 4.2% of patients were treated with interventionist procedures, and 2.1% of patients in a conservative way. 17.9% and 4.2% of patients came up with early and late complications, respectively. Early and late mortality occurred in 9.5% and 3.2% of patients, respectively. By March 2014, with a median follow up of 43.8 months, median overall survival for colorectal cancer patients was 2.7 years (95%IC, 2.0 - 3.2). Univariaye Cox Regresion analysis revealed the presence of cardiomyopathy (p = 0.024), the presence of chornic kidney disease (p = 0.025), the presence of comorbidities (vs absence) (0.026), the number of comorbidities (0.034), type of admission (p = 0.001), treatment with surgery (p = 0.001) and the incidence of early (p = 0.004) or late complications (p = 0.023) associated to overall survival with statically significance. Multivariate Cox Regression analysis showed number of comorbidities (HR = 1.104; 95%CI: 0.851 - 1.431; p = 0.456), treatment with surgery (HR = 4.928; 95%CI: 1.815 - 13.385; p = 0.002), programmed admission into hospital (HR = 2.316; 95%CI: 1.298 - 4.133; p = 0.004), and the incidence of late complications (HR = 4.629; 95%CI: 1.279 - 16.750; p = 0.020) independently associated with overall survival. Interaction test between number of comorbidities and early complication was performed (HR = 1.453; 95%CI: 0.971 - 2.175; p = 0.070). Conclusions: In our experience surgery for CRC patients may increase overall survival even in an extreme elderly population (380 years). Nevertheless when considering surgery for CRC in this subgroup of patients, factor such as type of admission into hospital and comorbidities should be taken into account in order to optimize treatment results in the effort to individualize CRC management in this growing population. 

Share and Cite:

Plazas, J. , Asensio, E. , Navalon, J. , Lozano, I. , Navarro, J. , Ricote, G. , Olcina, M. , Cotes, A. , Ore, H. , Magdaleno, A. , Ors, M. , Escudero, M. and Morcillo, M. (2015) Colorectal Cancer Surgery in Extreme Elderly Population. Journal of Cancer Therapy, 6, 12-20. doi: 10.4236/jct.2015.61002.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] van de Velde, C.J.H., Boelens, P.G., Tanis, P.J., et al. (2014) Experts Reviews of the Multidisciplinary Consensus Conference Colon and Rectal Cancer 2012: Science, Opinions and Experiences from the Experts of Surgery. European Journal of Surgical Oncology, 40, 454-468.
[3] Brenner, H., Bouvier, A.M., Foschi, R., et al. (2012) Progress in Colorectal Cancer Survival in Europe from the Late 1980s to the Early 21st Century: The EUROCARE Study. International Journal of Cancer, 131, 1649-1658.
[4] Jensen, H.E., Nielsen, J. and Balslev, I. (1970) Carcinoma of the Colon in Old Age. Annals of Surgery, 171, 107-115.
[5] Irvin, T.T. (1988) Prognosis of Colorectal Cancer in the Elderly. British Journal of Surgery, 75, 419-421.
[6] Boyd, J.B., Bradford Jr., B. and Watne, A.L. (1980) Operative Risk Factors of Colon Resection in the Elderly. Annals of Surgery, 192, 743-746.
[7] Dekker, J.W., Gooiker, G.A., Bastiaannet, E., et al. (2014) Cause of Death the First Year after Curative Colorectal Cancer Surgery; a Prolonged Impact of the Surgery in Elderly Colorectal Cancer Patients. European Journal of Surgical Oncology, 40, 1481-1487.
[8] Kolfschoten, N.E., Wouters, M.W., Gooiker, G.A., et al. (2012) Nonelective Colon Cancer Resections in Elderly Patients: Results from the Dutch Surgical Colorectal Audit. Digestive Surgery, 29, 412-419.
[9] Mamidanna, R., Eid-Arimoku, L., Almoudaris, A.M., et al. (2012) Poor 1-Year Survival in Elderly Patients Undergoing Nonelective Colorectal Resection. Diseases of the Colon & Rectum, 55, 788-796.
[10] Jemal, A., Murray, T., Ward, E., et al. (2005) Cancer Statistics, 2005. CA: A Cancer Journal for Clinicians, 55, 10-30.
[11] Goldberg, R.M., Tabah-Fisch, I., Bleiberg, H., de Gramont, A., Tournigand, C., Andre, T., et al. (2006) Pooled Analysis of Safety and Efficacy of Oxaliplatin plus Fluorouracil/Leucovorin Administered Bimonthly in Elderly Patients with Colorectal Cancer. Journal of Clinical Oncology, 24, 4085-4091.
[12] Ries, L.A.G., Harkins, D., Krapcho, M., et al., Eds. (2003) Contents of the SEER Cancer Statistics Review, 1975-2003. National Cancer Institute, Bethesda.
[13] Edwards, B.K., Howe, H.L., Ries, L.A.G., Thun, M.J., Rosenberg, H.M., Yancik, R., et al. (2002) Annual Report to the Nation on the Status of Cancer, 1973-1999, Featuring Implications of Age and Aging on US Cancer Burden. Cancer, 94, 2766-2792.
[14] Minino, A.M., Heron, M.P., Murphy, S.L., et al. (2007) Deaths: Final Data for 2004. National Vital Statistics Reports, 55, 1-119.
[15] (2007) Life Expectancy by Selected Ages since 1946: Females. Institut National D’tudes Démographiques, Paris. fr_sd2004_t69esp_fm.1.xls
[16] (2007) Life Expectancy by Selected Ages since 1946: Males. Institut National D’tudes Démographiques, Paris. fr_sd2004_t69esp_fm.1.xls
[17] Mitry, E., Bouvier, A.M., Esteve, J. and Faivre, J. (2005) Improvement in Colorectal Cancer Survival: A Population-Based Study. European Journal of Cancer, 41, 2297-2303.
[18] Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J., Murray, T. and Thun, M.J. (2008) Cancer Statistics, 2008. CA: A Cancer Journal for Clinicians, 58, 71-96.
[19] Yancik, R., Havlik, R.J., Wesley, M.N., Ries, L., Long, S., Rossi, W.K. and Edwards, B.K. (1996) Cancer and Comorbidity in Older Patients: A Descriptive Profile. Annals of Epidemiology, 6, 399-412.
[20] Coebergh, J.W.W., Janssen-Heijnen, M.L.G., Post, P.N. and Razenberg, P.P.A. (1999) Serious Comorbidity among Unselected Cancer Patients Newly Diagnosed in the Southeastern Part of The Netherlands in 1993-1996. Journal of Clinical Epidemiology, 52, 1131-1136.
[21] Zeber, J.E., Copeland, L.A., Hosek, B.J., Karnad, A.B., Lawrence, V.A. and Sanchez-Reilly, S.E. (2008) Cancer Rates, Medical Comorbidities, and Treatment Modalities in the Oldest Patients. Critical Reviews in Oncology/Hematology, 67, 237-242.
[22] Piccirillo, J.F., Tierney, R.M., Costas, I., Grove, L. and Spitznagel Jr., E.L. (2004) Prognostic Importance of Comorbidity in a Hospitalbased Cancer Registry. Journal of the American Medical Association, 291, 2441-2447.
[23] Geraci, J.M., Escalante, C.P., Freeman, J.L. and Goodwin, J.S. (2005) Comorbid Disease and Cancer: The Need for More Relevant Conceptual Models in Health Services Research. Journal of Clinical Oncology, 23, 7399-7404.
[24] Koroukian, S.M., Murray, P. and Madigan, E. (2006) Comorbidity, Disability, and Geriatric Syndromes in Elderly Cancer Patients Receiving Home Health Care. Journal of Clinical Oncology, 24, 2304-2310.
[25] Extermann, M., Overcash, J., Lyman, G.H., Parr, J. and Balducci, L. (1998) Comorbidity and Functional Status Are Independent in Older Cancer Patients. Journal of Clinical Oncology, 16, 1582-1587.
[26] Read, W.L., Tierney, R.M., Page, N.C., Costas, I., Govindan, R., Spitznagel, E.L.J. and Piccirillo, J.F. (2004) Differential Prognostic Impact of Comorbidity. Journal of Clinical Oncology, 22, 3099-3103.
[27] Gooiker, G.A., Dekker, J.W.T., Bastiaannet, E., van der Geest, L.G.M., Merkus, J.W.S., van de Velde, C.J.H., et al. (2012) Risk Factors for Excess Mortality in the First Year after Curative Surgery for Colorectal Cancer. Annals of Surgical Oncology, 19, 2428-2434.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.