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. 2022 Mar 21;22(1):302.
doi: 10.1186/s12885-022-09384-9.

Octogenarian patients with colon cancer - postoperative morbidity and mortality are the major challenges

Øystein Høydahl  1   2 , Tom-Harald Edna  3   4 , Athanasios Xanthoulis  3   4 , Stian Lydersen  5 , Birger Henning Endreseth  4   6
Affiliations

Octogenarian patients with colon cancer - postoperative morbidity and mortality are the major challenges

Øystein Høydahl et al. BMC Cancer. .

Abstract

Background: Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent.

Methods: All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 90-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival.

Results: Among 237 octogenarian patients treated with major resections with curative intent, the 90-day mortality was 9.3%. Among 215 patients that survived the first 90 days, the 5 year relative survival rate was 98.7%. The 90-day mortality of octogenarian patients was significantly higher than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 90-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 90-day and long-term survival rates improved over time.

Conclusion: Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 90-day mortality was high, but after surviving 90 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 90-day mortality risk.

Keywords: Colon cancer; Epidemiology; Octogenarians; Survival; Treatment.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Survival of patients with colon cancer during 1980–2016. a 5-year relative survival for all patients in each age group; table columns represent the number of patients at risk at surgery (time = 0) and every 1 year thereafter. b Long term relative survival for all patients, classified by treatment intent; table columns represent the number of patients at risk at surgery (time = 0) and every 2.5 years thereafter
Fig. 2
Fig. 2
Relative survival after colon cancer resection with curative intent in patients that survived 90 days. Relative survival is stratified by age group. Table columns represent the number of patients at risk at surgery (time = 0) and every 2.5 years thereafter
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