Association between age and surgical resection for patients with stage II or III colorectal cancer: national study

Introduction Elderly patients with colorectal cancer (CRC) are less likely to undergo surgical resection. This study investigated the association between age and surgical resection, stratified by Eastern Cooperative Oncology Group performance status (PS), co-morbidities, tumour site, and mode of presentation. Methods Using national data from 2017–2022, patients diagnosed with stage II–III CRC in the English National Health Service were identified. The primary outcome was receipt of surgical resection. Risk-adjusted rates of surgical resection by age were estimated using multilevel multivariable logistic regression, testing for interactions with PS, co-morbidities, tumour site, and mode of presentation. Between-hospital variation in rates of surgical resection was also examined. Results Overall, 63 698 of 79 763 patients (79.9%) underwent surgical resection during the study period. PS substantially modified the relationship between age and surgery. After risk adjustment, approximately 90% of fit patients (PS 0 or 1) underwent surgery up to age 75 years, with a steep decline by age 90 years to 61.8% (95% confidence interval (c.i.) 58.3% to 65.3%) and 48.8% (95% c.i. 45.9% to 51.7%) for PS 0 and 1, respectively. For patients too unfit to work (PS ≥ 2), the adjusted rate of surgery was lower and declined earlier, from around 80% at age 60 years, and then more gradually to 25.7% (95% c.i. 23.5% to 27.8%) at age 90 years. After adjustment, between-hospital variation was larger in patients aged > 75 years than in younger patients (interquartile range 60.7–74.7% versus 84.9–90.7%, respectively). Conclusion In patients fit enough to work, age is not associated with surgical decision-making until around age 75 years. In less fit patients, age is a key factor in decision-making across all ages. Substantial variation in rates of surgery between hospitals highlights the need for evidence-based guidelines to support equitable access to potentially curative treatment.