TITLE:
Colorectal Cancer Surgery in Extreme Elderly Population
AUTHORS:
Javier Gallego Plazas, Elena Asensio, Juan C. Navalon, Inmaculada Lozano, Jose M. Navarro, Guillermo Ricote, Montse Olcina, Almudena Cotes, Henry M. Ore, Alejandra Magdaleno, Maria C. Ors, Maria J. Escudero, Miguel A. Morcillo
KEYWORDS:
Colorectal, Cancer, Surgery, Elderly
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.6 No.1,
December
26,
2014
ABSTRACT: 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 patients380 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 suchas 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.