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Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group.

Publication ,  Journal Article
Published in: Lancet
September 16, 2000

BACKGROUND: The effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives, with an improved postoperative life expectancy, or at least one that is not diminished by the surgery. Because colorectal cancer is a major cause of morbidity and mortality in elderly people, we have examined how the outcomes of surgery in elderly patients differ from those in younger patients. METHODS: We did a systematic review of published and aggregate data provided by investigators. Studies were identified by computerised and manual searches of published and unpublished reports, scanning references, and contacting investigators. Within each study, outcomes for patients aged 65-74 years, 75-84 years, and 85+ years were expressed in relation to those aged less than 65 years. FINDINGS: From 28 independent studies, and a total of 34,194 patients, we found that elderly patients had an increased frequency of comorbid conditions, were more likely to present with later-stage disease and undergo emergency surgery, and less likely to have curative surgery than younger patients. The incidence of postoperative morbidity and mortality increased progressively with advancing age. Overall survival was reduced in elderly patients, but for cancer specific survival age-related differences were much less striking. INTERPRETATION: The relation between age and outcomes from colorectal cancer surgery is complex and may be confounded by differences in stage at presentation, tumour site, pre-existing comorbidities, and type of treatment received. However, selected elderly patients benefit from surgery since a large proportion survive for 2 or more years, irrespective of their age.

Duke Scholars

Published In

Lancet

ISSN

0140-6736

Publication Date

September 16, 2000

Volume

356

Issue

9234

Start / End Page

968 / 974

Location

England

Related Subject Headings

  • Survival Rate
  • Prognosis
  • Postoperative Complications
  • Middle Aged
  • Life Expectancy
  • Length of Stay
  • Humans
  • General & Internal Medicine
  • Comorbidity
  • Colorectal Neoplasms
 
Journal cover image

Published In

Lancet

ISSN

0140-6736

Publication Date

September 16, 2000

Volume

356

Issue

9234

Start / End Page

968 / 974

Location

England

Related Subject Headings

  • Survival Rate
  • Prognosis
  • Postoperative Complications
  • Middle Aged
  • Life Expectancy
  • Length of Stay
  • Humans
  • General & Internal Medicine
  • Comorbidity
  • Colorectal Neoplasms