Int J Colorect Dis (1990) 5:25-30
Col6reeial Disease
9 Springer-Verlag 1990
Surgery for carcinoma of the colon in people aged 75 years and older J.P. Ozoux, L. de Calan, M. Perrier, C. Berton, J.P. Favre and J. Brizon Service de Chirurgie Digestive, H6pital Bretonneau, Tours, France Accepted: 6 December 1989
Abstract. F r o m J a n u a r y 1976 to June 1986, 154 p a t i e n t s (75 m e n a n d 79 w o m e n ) w h o were 75 years o f age or o l d e r were a d m i t t e d for the surgical t r e a t m e n t o f a c o l o n i c cancer. T h e m e a n age was 80.7 years. P a t i e n t s were div i d e d into two g r o u p s : 66 p a t i e n t s , b e t w e e n 75 a n d 80 years o f age, were in G r o u p I; 88 p a t i e n t s , 80 y e a r s o f age a n d older, were in G r o u p II. O n e h u n d r e d a n d f o r t y - t h r e e p a t i e n t s ( 9 3 % ) were o p e r a t e d o n a n d a resection was c a r r i e d o u t in 125 p a t i e n t s (87%). T h e overall p o s t - o p e r ative m o r t a l i t y r a t e was 12% ( G r o u p I: 5%; G r o u p II: 17%; p < 0.02). T h e a c t u a r i a l survival r a t e o f p a t i e n t s o p e r a t e d o n was 32_+8% at 3 y e a r s a n d 26+_8% at 5 y e a r s ( G r o u p I: 3 7 % ; G r o u p II: 17%). In b o t h g r o u p s the survival rate was closely r e l a t e d to the extent o f the disease a c c o r d i n g to D u k e s classification. These results suggest t h a t in the 75 80 y e a r g r o u p age a l o n e s h o u l d no l o n g e r be c o n s i d e r e d a m a j o r risk f a c t o r for i m m e d i a t e surgical o u t c o m e . I n p a t i e n t s a g e d 80 a n d older, the results are w o r s e b u t it is n o t a d v a n c e d age p e r se w h i c h influences m o r t a l i t y , r a t h e r the p h y s i o l o g i c status o f the patient.
Introduction
Patients and methods P a tien ts
In accordance with the World Health Organisation Classification of Elderly People and geriatric classifications (Silverberg and Cassel cited by Bader [5]), the minimum age was set at 75 years old. One hundred and fifty-four patients older than 75 years were hospitalised between January 1976 and June 1986 for colonic cancer, excluding rectal cancers (tumours located less than 15 cm from the anal margin). There were 75 men and 79 women; median age was 80.7 (82 for women and 79.5 for men; range from 75 to 97 years old) (Fig. 1). The patients were separated into 2 groups: group I, patients between 75 and 79 years old (n = 66) and group II, patients older than 80 years old (n = 88). Tumour distribution according to location is shown in Fig. 2. There were no differences in localisation with respect to age (30% right-sided cancers and 50% left-sided cancers in group I compared to 37% right-sided cancers and 47% left-sided cancers in group II). More women had a right-sided cancer (77% vs 23%) while more men had a left sided cancer (65% vs 35%) (p < 0.01). Sixty-two percent of left-sided cancers and 37% of right-sided cancers were discovered following a change in bowel habit. Twenty-seven percent of the patients had a palpable abdominal mass. Most of these were located in the right colon and were
No of p a t i e n t s 70
T h e n u m b e r o f elderly p e o p l e is i n c r e a s i n g in m a n y c o u n tries [1]. In 1985, the N a t i o n a l I n s t i t u t e o f Statistics a n d E c o n o m i c Studies census f o u n d 700 000 F r e n c h p e o p l e o l d e r t h a n 85 years o f age. T h e r e will be 1 m i l l i o n in the y e a r 2000 a n d 2.5 m i l l i o n in 2040. C a n c e r is the s e c o n d l e a d i n g cause o f d e a t h in these elderly p e o p l e , with colorectal c a n c e r being the s e c o n d m o s t f r e q u e n t cancer, b e h i n d b r e a s t c a n c e r in w o m e n a n d b r o n c h o g e n i c c a n c e r in m e n [2]. In F r a n c e , as in o t h e r countries, c a n c e r registries i n d i c a t e t h a t one t h i r d o f the c o l o r e c t a l cancers o c c u r in elderly p e o p l e [3, 4]. We h a v e a t t e m p t e d to a n a lyse the s h o r t - t e r m a n d l o n g - t e r m t r e a t m e n t results in this p o p u l a t i o n in o r d e r to d e t e r m i n e w h e t h e r c o l o n i c c a n c e r has a w o r s e p r o g n o s i s in elderly p e o p l e a n d w h e t h e r age s h o u l d be a f a c t o r in t h e r a p e u t i c d e c i s i o n - m a k i n g .
60
50
40
30
20
10
Years
0 75 - 8 0
80 - 85
85 - 90
90 a n d +
Fig. 1. Carcinoma of the colon in patients aged 75 years and over. Age and sex distribution
26 clinically detectable in 53 %. Thirty-ninecancers (25%) were discovered following a complication. Left sided obstruction was more frequent than right sided obstruction (22% vs 7%) (p < 0.05); group II had more frequent complications (32%) than group I (17%) (p
Col6reeial Disease
9 Springer-Verlag 1990
Surgery for carcinoma of the colon in people aged 75 years and older J.P. Ozoux, L. de Calan, M. Perrier, C. Berton, J.P. Favre and J. Brizon Service de Chirurgie Digestive, H6pital Bretonneau, Tours, France Accepted: 6 December 1989
Abstract. F r o m J a n u a r y 1976 to June 1986, 154 p a t i e n t s (75 m e n a n d 79 w o m e n ) w h o were 75 years o f age or o l d e r were a d m i t t e d for the surgical t r e a t m e n t o f a c o l o n i c cancer. T h e m e a n age was 80.7 years. P a t i e n t s were div i d e d into two g r o u p s : 66 p a t i e n t s , b e t w e e n 75 a n d 80 years o f age, were in G r o u p I; 88 p a t i e n t s , 80 y e a r s o f age a n d older, were in G r o u p II. O n e h u n d r e d a n d f o r t y - t h r e e p a t i e n t s ( 9 3 % ) were o p e r a t e d o n a n d a resection was c a r r i e d o u t in 125 p a t i e n t s (87%). T h e overall p o s t - o p e r ative m o r t a l i t y r a t e was 12% ( G r o u p I: 5%; G r o u p II: 17%; p < 0.02). T h e a c t u a r i a l survival r a t e o f p a t i e n t s o p e r a t e d o n was 32_+8% at 3 y e a r s a n d 26+_8% at 5 y e a r s ( G r o u p I: 3 7 % ; G r o u p II: 17%). In b o t h g r o u p s the survival rate was closely r e l a t e d to the extent o f the disease a c c o r d i n g to D u k e s classification. These results suggest t h a t in the 75 80 y e a r g r o u p age a l o n e s h o u l d no l o n g e r be c o n s i d e r e d a m a j o r risk f a c t o r for i m m e d i a t e surgical o u t c o m e . I n p a t i e n t s a g e d 80 a n d older, the results are w o r s e b u t it is n o t a d v a n c e d age p e r se w h i c h influences m o r t a l i t y , r a t h e r the p h y s i o l o g i c status o f the patient.
Introduction
Patients and methods P a tien ts
In accordance with the World Health Organisation Classification of Elderly People and geriatric classifications (Silverberg and Cassel cited by Bader [5]), the minimum age was set at 75 years old. One hundred and fifty-four patients older than 75 years were hospitalised between January 1976 and June 1986 for colonic cancer, excluding rectal cancers (tumours located less than 15 cm from the anal margin). There were 75 men and 79 women; median age was 80.7 (82 for women and 79.5 for men; range from 75 to 97 years old) (Fig. 1). The patients were separated into 2 groups: group I, patients between 75 and 79 years old (n = 66) and group II, patients older than 80 years old (n = 88). Tumour distribution according to location is shown in Fig. 2. There were no differences in localisation with respect to age (30% right-sided cancers and 50% left-sided cancers in group I compared to 37% right-sided cancers and 47% left-sided cancers in group II). More women had a right-sided cancer (77% vs 23%) while more men had a left sided cancer (65% vs 35%) (p < 0.01). Sixty-two percent of left-sided cancers and 37% of right-sided cancers were discovered following a change in bowel habit. Twenty-seven percent of the patients had a palpable abdominal mass. Most of these were located in the right colon and were
No of p a t i e n t s 70
T h e n u m b e r o f elderly p e o p l e is i n c r e a s i n g in m a n y c o u n tries [1]. In 1985, the N a t i o n a l I n s t i t u t e o f Statistics a n d E c o n o m i c Studies census f o u n d 700 000 F r e n c h p e o p l e o l d e r t h a n 85 years o f age. T h e r e will be 1 m i l l i o n in the y e a r 2000 a n d 2.5 m i l l i o n in 2040. C a n c e r is the s e c o n d l e a d i n g cause o f d e a t h in these elderly p e o p l e , with colorectal c a n c e r being the s e c o n d m o s t f r e q u e n t cancer, b e h i n d b r e a s t c a n c e r in w o m e n a n d b r o n c h o g e n i c c a n c e r in m e n [2]. In F r a n c e , as in o t h e r countries, c a n c e r registries i n d i c a t e t h a t one t h i r d o f the c o l o r e c t a l cancers o c c u r in elderly p e o p l e [3, 4]. We h a v e a t t e m p t e d to a n a lyse the s h o r t - t e r m a n d l o n g - t e r m t r e a t m e n t results in this p o p u l a t i o n in o r d e r to d e t e r m i n e w h e t h e r c o l o n i c c a n c e r has a w o r s e p r o g n o s i s in elderly p e o p l e a n d w h e t h e r age s h o u l d be a f a c t o r in t h e r a p e u t i c d e c i s i o n - m a k i n g .
60
50
40
30
20
10
Years
0 75 - 8 0
80 - 85
85 - 90
90 a n d +
Fig. 1. Carcinoma of the colon in patients aged 75 years and over. Age and sex distribution
26 clinically detectable in 53 %. Thirty-ninecancers (25%) were discovered following a complication. Left sided obstruction was more frequent than right sided obstruction (22% vs 7%) (p < 0.05); group II had more frequent complications (32%) than group I (17%) (p
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