Colorectal cancer surgery in the elderly: limitations and drawbacks

Purpose The purpose of this study was to evaluate the outcomes of colorectal cancer surgery among the elderly. Methods From March 2002 until February 2010, 434 patients who presented to our institution with the initial diagnosis of colorectal cancer and were submitted to open curative colorectal cancer resections or some kind of palliative procedure either elective or emergencies were retrospectively reviewed. A total of 286 of these patients (65.8%) were below 75 years (group A) and 148 (34.2%) above 75 years (group B). Results A procedure with curative intent was undertaken in 386 patients (88.9%), while forty-eight patients (11.1%) were submitted to a palliative procedure. Regarding the incidence of emergency operations, forty-five patients (15.7%) from group A and forty-four patients (29.7%) from group B were operated due to an emergency (obstructing, perforating or bleeding tumors; P < 0.001). Mean ASA score was 1.74 +/- 0.84 and 2.32 +/- 0.94 for groups A and B, respectively (P < 0.001). Mean TNM stage was 2.28 +/- 1.00 and 2.74 +/- 0.98 for groups A and B, respectively (P = 0.0001). Elderly patients exhibited increased incidence of post-operative complications and increased post-operative mortality compared with their younger counterparts (P = 0.002 and 0.001, respectively). Conclusion Colorectal cancer surgery in the elderly is a challenging clinical scenario. Treatment decision adjusted to each individual case is the ideal practice in order to maintain an acceptable balance between curative cancer resections and palliative procedures.