Introduction With an increasing elderly population we are more frequently having to address treatment of colorectal cancer in those over 80. Despite this, there is relatively little published UK data for these patients. North Wales has a significantly higher than average elderly population and our aim was to evaluate the treatment of colorectal cancer in those 80 years and older.
Method This was a retrospective observational study. Data from the north wales cancer registry was used to identify all patients with a diagnosis of colorectal cancer from January 2009–July 2014. Patient case details were then cross referenced with local coding data, clinical/histopathological records and imaging records.
We analysed diagnosis, treatment including operation (open versus laparoscopic and elective versus emergency). For those operated on we include 30 day mortality and length of hospital stay. Data for those aged 80 or over was compared to those under 80 using SPSS software.
Results There were 942 total patients, of which 243 were over the age of 80(26%). 102 of 243(42%) were female. Age range was 80–110(Mean = 85). Significantly less of those over 80 underwent cancer resection (64% vs. 80% p = 0.0000). This was despite no significant difference in disease severity at diagnosis (p = 0.198). Overall 30 day mortality post surgery in the elderly resection group was worse when compared to the under 80 group (12.8% vs. 3% p = 0.0000).
Of elderly patients undergoing elective surgical resection, 46% were laparoscopic compared to 52% in the under 80 group. 30 day mortality of the elderly laparoscopic group was significantly worse when compared to the under 80 group (10% vs. 2.6%) p = 0.015, however this difference was less sizeable than in open surgery category.
Significantly more of the over 80s presented as an emergency (16% vs. 12% p = 0.008). Three quarters of the elderly emergency patients underwent surgery, for which the 30 day mortality was 23% compared to 6% of the under 80s (p = 0.0001).
Length of stay was significantly higher in the over 80 group (p = 0.0001) with the average length of stay at (18.2 days vs. 13.1 days). Postoperative stay in elderly group was significantly more in open procedure than laparoscopic (Mean no days 21.0 vs. 14.4 P = 0.001).
Conclusion Patients over 80 years old form a quarter of our colorectal cancer burden, and are more likely to present as emergencies and require longer hospital stays post operatively. Despite the perceived increased risks in this age group our data demonstrates we are performing resection surgery for a significant proportion with acceptable outcomes. Our data also supports the benefits of laparoscopic surgery in this age group.
Disclosure of interest None Declared.
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