Perioperative and oncologic outcomes in young and octogenarian patients with colorectal cancer: a comparison at the extremes

• Published in: Langenbeck's archives of surgery Vol. 406; no. 7; pp. 2399 - 2408
• Main Authors: Chan, Dedrick Kok Hong, Leong, Sze Wai, Keh, Christopher Hang Liang
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2021
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Original Article; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Octogenarian; Outcomes; Colorectal cancer; Young cancer
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-021-02275-w

Introduction In colorectal cancer (CRC), surgical outcomes in the young (< 50) and octogenarian populations are believed to be poor due to an aggressive phenotype in the former, and increased frailty in the latter. Given that age-related effects are inversely related between groups, we compared short- and long-term outcomes of young and octogenarian patients with CRC to determine the dominance of one age-related factor over another. Methods A prospectively collected database from 2015 to 2020 of all CRC was analyzed. Cases were divided into metastatic and non-metastatic groups. Results Among non-metastatic cases, there were 34 young and 113 octogenarian patients. Mean CEA was higher among octogenarians (11.2 vs 32.8 units/ml; p  = 0.041). Octogenarians suffered from more comorbidities than younger counterparts, with increased rates of postoperative UTI (3.3% vs 10.3%; p  = 0.246) and pneumonia (3.1% vs 8.8%; p  = 0.331). There was no increased rate of reintervention or Clavien-Dindo scores. We noticed a statistically significant higher proportion of extramural vascular invasion (EMVI) (8.8% vs 32.3%; p  = 0.003) among the young. When excluding octogenarians who had declined surgery, Kaplan–Meier analysis showed no difference in disease-free ( p  = 0.290) or overall survival ( p  = 0.111). Among metastatic cases, there were 21 young and 19 octogenarian patients. Young patients were treated more aggressively with chemotherapy (55.6% vs 12.5%; p  = 0.040). There was however no difference in overall survival between groups ( p  = 0.610). Conclusions Octogenarians may have more comorbidities, but can achieve similar surgical outcomes with younger patients. There is no reason to suspect a more aggressive phenotype in younger patients.