Mäkelä J T, Kiviniemi H, Laitinen S
Department of Surgery, Oulu University Hospital, Finland.
Eur J Surg. 2000 Jun;166(6):473-9. doi: 10.1080/110241500750008790.
To define factors that predict mortality and survival in patients with colorectal cancer who are aged 75 or over.
Retrospective study.
University hospital, Finland.
231 patients aged 75 or over who were admitted to hospital with colorectal cancer during the 14-year period 1980-93.
Morbidity, mortality, recurrence, and survival.
In-hospital mortality after any kind of operation was 8/211 (4%), and 8/175 (5%) of those who had their tumours resected. Morbidity was 35/175 (20%). Factors associated with mortality were weight loss, Dukes'stage, extent of resection, and type of operation. Overall 5-year survival was 28%, overall 10-year survival was 4%, and median survival was 33 months (range 0-150). Survival was most closely related to Duke's stage, extent of resection, and recurrent disease on univariate analysis, but multivariate analysis identified only mode of recurrence (p < 0.0001), recurrent disease (p < 0.004), and extent of resection (p < 0.009) as independent predictors of survival. The recurrence rate after radical resection was 49/141 (35%) and the median disease-free interval was 10 months (range 4-64). Mortality after resection for recurrent cancer was 3/17 (18%) and morbidity 5/17 (29%).
Age alone is not a risk factor for postoperative mortality or a predictor of long-term survival. Low mortality and acceptable long-term survival can be achieved in patients aged 75 or over if those with extensive distant metastases, and those whose general condition is too poor to stand a major operation, are treated conservatively.
