Key result
Elderly patients with colorectal cancer emergencies undergo ~32% fewer curative surgeries despite comparable 30-day mortality.
Why the study?
Colorectal cancer is predominantly a disease of the elderly, with up to 30% presenting as an emergency, prompting a comparison of emergency outcomes between elderly and younger patients.
Does elderly age (≥ 75 years) affect treatment and survival outcomes in patients presenting with a colorectal cancer emergency compared to younger patients?
Cohort (n=341)
No
Does elderly age (≥ 75 years) affect treatment and survival outcomes in patients presenting with a colorectal cancer emergency compared to younger patients?
Despite higher complication rates and lower rates of curative surgery, elderly patients undergoing curative surgery for colorectal cancer emergencies have comparable short- and medium-term survival to younger patients.
Answers are grounded in this paper and cite their sources.
Supports individualized curative surgery decisions in elderly colorectal emergencies; leaves open optimal age-based selection criteria.
AIM: Colorectal cancer is predominantly a disease of the elderly and up to 30% of these patients will present as an emergency. We compared the outcomes of 'elderly' patients presenting to our unit with a colorectal cancer emergency over a 10-year period with those of a 'younger' cohort. METHODS: A single centre retrospective review of colorectal cancer emergencies between 1 April 2007 and 1 April 2017 was performed. Patients were separated into two cohorts: 'young' (< 75 years) and 'elderly' (≥ 75 years). Data collected included demographics, disease status, treatment and outcomes. RESULTS: A total of 341 patients (< 75 years: n = 154; ≥ 75 years: n = 187) presented as a colorectal cancer emergency. Significantly fewer 'elderly' patients underwent curative surgical procedures (72% vs 49%, P < 0.0001) or received adjuvant chemotherapy (56% vs 21%, P < 0.0001). 'Elderly' patients had significantly more postoperative cardio-respiratory complications (7% vs 36%, P < 0.0001), but despite this there was no significant difference in 30-day mortality (7% vs 12%) and survival rates at 1 year (75% vs 74%) or 3 years (56% vs 49%). Elderly patients treated with best supportive care had a median overall survival of just 62 (range 1-955) days. CONCLUSION: Patients ≥ 75 years presenting as a colorectal cancer emergency were significantly less likely to undergo emergency curative surgery or receive adjuvant chemotherapy than those < 75 years. However, the 30-day mortality, 1- and 3-year survival rates for patients undergoing curative surgery were comparable.
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Webster et al. (2020) conducted a cohort in Colorectal cancer emergency (n=341). Elderly age (≥ 75 years) vs. Younger age (< 75 years) was evaluated on Curative surgical procedures (p=<0.0001). Elderly patients (≥75 years) with colorectal cancer emergencies underwent fewer curative surgeries than younger patients but had comparable 30-day mortality.
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