Should we resect colorectal cancer in patients over the age of 85?

Table 1 Demographic and comorbidity data on patients from 75-85 years old and those ≥ 85 years old

Feature	Number of 75-85 years old patients (% of 75-85 years old patients)	Number of ≥ 85 years old patients (% of ≥ 85 years old patients)	Total	P value
Patients	136	48	184
Gender
Male	66 (49)	15 (31)	81	0.043
Female	70 (51)	33 (69)	103
Median BMI	26	25
Range	15-40	16-40
< 20	2 (1)	2 (4)	4	0.14
20-24.9	44 (32)	24 (50)	67
25-29.9	50 (37)	16 (33)	65
30-39.9	31 (23)	5 (10)	36
> 40	9 (7)	1 (2)	10
ASA
Grade I	4 (3)	1 (2)	5	0.43
Grade II	29 (21)	8 (17)	37
Grade III	84 (62)	29 (60)	113
Grade IV	19 (14)	9 (19)	28
Grade V	0 (0)	1 (2)	1
Cardiac
Ischaemic heart disease	34 (25)	16 (34)	50	0.27
Coronary artery bypass graft	20 (15)	5 (11)	25	0.025
Percutaneous coronary intervention	9 (7)	4 (9)	13	0.75
Pacemaker insertion	4 (3)	0 (0)	4	0.57
Cardiac valve replacement	6 (4)	3 (6)	9	0.61
Heart failure (all types)	8 (6)	3 (6)	11	1.0
Cardiomyopathy	6 (4)	3 (6)	9	0.61
AICD insertion	1 (1)	1 (2)	2	0.44
Hypertension	85 (63)	34 (71)	119	0.38
Pulmonary hypertension	3 (2)	0 (0)	3	0.57
Atrial fibrillation	28 (21)	12 (25)	40	0.55
Respiratory
Asthma	21 (15)	4 (8)	25	0.33
COPD	22 (16)	4 (8)	26	0.23
Bronchiectasis	0 (0)	2 (4)	2	0.017
Cystic fibrosis	0 (0)	0 (0)	0	-
Obstructive sleep apnoea	10 (7)	0 (0)	10	0.066
Metabolic
Type I Diabetes	0 (0)	0 (0)	0	-
Type II Diabetes	27 (20)	11 (23)	38	0.68
Hyperlipidaemia	52 (38)	21 (44)	73	0.61
Previous cancer	31 (23)	10 (21)	11	0.78
Autoimmune
Rheumatoid arthritis	1 (1)	1 (2)	2	0.44
Psoraisis	5 (4)	1 (2)	6	0.59
Polymyalgia rheumatica	1 (1)	2 (4)	3	0.11
SLEII	1 (1)	0 (0)	1	0.55
Pre-operative renal function
eGFR > 90	46 (34)	12 (25)	58	0.007
eGFR 60-89	63 (46)	15 (31)	78
eGFR 45-59	18 (13)	15 (31)	33
eGFR 30-44	9 (7)	5 (11)	14
eGFR 15-29	0 (0)	1 (2)	1
eGFR < 15	0 (0)	0 (0)	0
Current smoker (within 12 mo)	7 (5)	1 (2)	8	0.68

BMI: Body mass index; ASA: American Society of Anaesthesiologists Physical Status Classifications; COPD: Chronic obstructive pulmonary disease; AICD: Automated implantable cardiac defibrillator; eGFR: Estimated glomerular filtration rate; SLE: Systemic lupus erythematosus.

Table 2 Surgical and pathological data of patients from 75-85 years old and those ≥ 85 years old

Feature	Number of 75-85 years old patients (% of 75-85 years old patients)	Number of ≥ 85 years old patients (% of ≥ 85 years old patients)	Total	P value
Patients	136	48	184
Surgical urgency
Emergency	24 (18)	9 (19)	33	0.35
Urgent	101 (74)	38 (79)	139
Elective	11 (8)	1 (2)	12
Location of cancer
Caecum to transverse colon	83 (61)	35 (73)	118	0.24
Splenic flexure to sigmoid	43 (32)	9 (19)	52
Rectum/anus	12 (9)	4 (8)	16
Type of operation
Left hemicolectomy	8 (6)	1 (2)	9	0.49
Right hemicolectomy	66 (49)	30 (63)	96
Extended right hemicolectomy	14 (10)	4 (8)	18
Total colectomy	1 (1)	0 (0)	1
Subtotal colectomy	3 (2)	1 (2)	4
High anterior resection	24 (18)	3 (6)	30
Low anterior resection	5 (4)	3 (6)	8
Ultralow anterior resection	2 (1)	0 (0)	2
Hartmann’s procedure	6 (4)	4 (8)	10
Abdominoperineal resection	1 (1)	0 (0)	1
Appendicectomy	2 (1)	0 (0)	2
Other	4 (3)	2 (4)	5
Approach
Laparoscopic	60 (44)	25 (52)	85	0.50
Laparoscopic assisted	31 (23)	12 (25)	43
Laparoscopic converted to open	14 (10)	2 (4)	16
Open (including local excision)	31 (23)	9 (19)	40
Histological diagnosis
Adenocarcinoma	117 (86)	38 (79)	155	0.46
Mucinous adenocarcinoma	17 (13)	10 (21)	27
Other	2 (1)	0 (0)	2
Histological grade
Low grade	97 (72)	34 (72)	131	1.0
High grade	37 (28)	13 (28)	50
No grade	2 (0)	1 (2)	3
Curability
Curative	125 (91)	41 (85)	166	0.19
Palliative due to metastases	11 (8)	7 (15)	18
Disease stage (at time of operation)
Stage I	19 (14)	11 (23)	30	0.57
Stage IIa	39 (29)	11 (23)	50
Stage IIb	14 (10)	7 (15)	21
Stage IIIa	4 (3)	2 (4)	6
Stage IIIb	29 (22)	6 (13)	35
Stage IIIc	10 (8)	5 (10)	15
Stage IV	19 (14)	6 (13)	25

Table 3 Complications encountered in patients in the 85+ group when compared to the 75-85 years old group

Complication	Number of 75-85 years old patients (% of 75-85 years old patients)	Number of ≥ 85 years old patients (% of ≥ 85 years old patients)
Surgical Complications
Abdominopelvic collection	3 (2)	3 (8)
Anastomotic leak	4 (3)	0
Superficial wound dehiscence	1 (1)	1 (3)
Wound infection	11 (7)	0
Prolonged ileus	26 (17)	4 (11)
Urinary retention	2 (1)	0
Post-operative haemorrhage	1 (1)	0
Anastomotic leak	4 (3)	0
Medical complications
Deep vein thrombosis	3 (2)	0
Pulmonary embolism	1 (1)	0
Respiratory infection	15 (10)	1 (3)
Ischaemic cardiac event	1 (1)	2 (5)
Cardiac arrhythmia	20 (13)	2 (5)
Cerebrovascular event	1 (1)	1 (3)
Respiratory failure	5 (3)	3 (8)
Renal insult	6 (4)	2 (5)

Table 4 Short term surgical outcomes in the 85+ group when compared to those in the 75-85 years old group

Feature	Number of 75-85 years old patients (% of 75-85 years old patients)	Number of ≥ 85 years old patients (% of ≥ 85 years old patients)	Total	P value
Patients	136	48	184
Median LOS (d)	8 (IQR = 6)	8 (IQR = 6)
< 14 d	96 (71)	30 (63)	126	0.29
≥ 14 d	40 (29)	18 (38)	58
30-d mortality	3 (2)	1 (2)	4	0.96
Clavien-Dindo complication
No complications	50 (37)	17 (35)	67	0.93
Grade I	13 (10)	5 (11)	18
Grade II	43 (32)	18 (38)	61
Grade IIIa	14 (10)	5 (10)	19
Grade IIIb	4 (3)	1 (2)	5
Grade IVa	8 (6)	1 (2)	9
Grade IVb	1 (1)	0 (0)	2
Grade V	3 (2)	1 (2)	3

LOS: Length of stay; IQR: Inter-quartile range.

Table 5 Short term outcomes in laparoscopic vs open resection of colorectal cancer in those over 85 years old

Feature	Open procedure	Laparoscopic procedure	Total	P value
Patients	11 (23)	37 (77)	48
Median LOS (d)	9 (IQR = 6)	8 (IQR = 6)
< 14 d	5 (45)	25 (68)	30	0.18
≥ 14 d	6 (55)	12 (32)	18
Gender
Male	3 (28)	12 (33)	15	1.0
Female	8 (73)	25 (68)	33
30 d mortality	1 (9)	0 (0)	1	0.063
Surgical urgency
Emergency	6 (55)	3 (8)	9	0.002
Urgent	5 (45)	33 (90)	38
Elective	0 (0)	1 (3)	1
Clavien-Dindo complication
No complications	4 (37)	13 (35)	17	0.46
Grade I	0 (0)	5 (14)	5
Grade II	5 (46)	13 (35)	18
Grade IIIa	1 (9)	4 (10)	5
Grade IIIb	0 (0)	1 (3)	1
Grade IVa	0 (0)	1 (3)	1
Grade IVb	0 (0)	0 (0)	0
Grade V	1 (9)	0 (0)	1

LOS: Length of stay; IQR: Inter-quartile range.