Factors affecting prognosis and management of carcinoma of the colon and rectum in patients more than eighty years of age

Abstract

Background: The safety and efficacy of operations for gastrointestinal diseases in very elderly patients has been a matter of debate in recent years.

Study design: One hundred seventy-seven instances of carcinoma of the colon and rectum in patients more than 80 years of age who wee surgically treated between 1961 and 1987 were reviewed. They were compared with 623 similar instances in patients younger than 80 years of age who were treated during the same time period.

Results: Octogenarians and nonagenarians significantly more often displayed obstruction or perforation, elevated preoperative carcinoembryonic antigen, right-sided lesions, and solitary hepatic metastases, when present. Patients more than 80 years of age received adjuvant chemotherapy or radiotherapy less often. Carcinoma recurrence in very elderly patients implied a very poor prognosis, with only a 4 percent salvage rate. The actuarial five year survival rate was 32 percent for the older patients and 48 percent in the younger group (p < 0.05). There was no significant difference in operative mortality between the two groups.

Conclusions: In general, age alone should not alter treatment strategy in patients with carcinoma of the colon and rectum.