Key result
Octogenarian patients with colon cancer undergoing major resection with curative intent had a significantly higher 90-day mortality compared to younger patients, though long-term relative survival among 90-day survivors was comparable.
Why the study?
Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients.
Does major resection with curative intent for colon cancer in octogenarian patients yield comparable long-term survival to younger patients?
Cohort (n=1,530)
No
Does major resection with curative intent for colon cancer in octogenarian patients yield comparable long-term survival to younger patients?
Odds Ratio: 3.9 (95% CI 1.6–9.52)
Absolute Event Rate: 7.6% vs 0.4%
p-value: p=0.003
Octogenarian patients undergoing curative colon cancer resection have high 90-day mortality, but those who survive the initial postoperative period have long-term relative survival comparable to younger patients.
Supports heightened perioperative caution for octogenarians; leaves open optimal selection criteria and validation in prospective cohorts.
BACKGROUND: Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients. The present study aimed to evaluate the relative survival of octogenarian patients after a major resection of colon cancer with a curative intent. METHODS: All patients diagnosed with colon cancer at Levanger Hospital between 1980 and 2016 were included. We performed logistic regression to test for associations between 90-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival. RESULTS: Among 237 octogenarian patients treated with major resections with curative intent, the 90-day mortality was 9.3%. Among 215 patients that survived the first 90 days, the 5 year relative survival rate was 98.7%. The 90-day mortality of octogenarian patients was significantly higher than that of younger patients, but the long-term survival converged with that of younger patients. Among octogenarian patients, the incidence of colon cancer more than doubled during our 37-year observation period. The relative increase in patients undergoing surgery exceeded the increase in incidence; hence, more patients were selected for surgery over time. A high 90-day mortality was associated with older age, a high American Society of Anaesthesiologists (ASA) score, and emergency surgery. Moreover, worse long-term survival was associated with a high Charlson Comorbidity Index, a high ASA score, a worse TNM stage, emergency surgery and residual tumours. Both the 90-day and long-term survival rates improved over time. CONCLUSION: Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 90-day mortality was high, but after surviving 90 days, the relative long-term survival rate was comparable to that of younger patients. Further improvements in survival will primarily require measures to reduce the 90-day mortality risk.
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Høydahl et al. (2022) conducted a cohort in Colon cancer (n=1,530). Octogenarian age (80-89 years) vs. Younger patients (<65 years) was evaluated on 90-day mortality after major resection with curative intent (age 80-84 vs <65 years) (OR 3.90, 95% CI 1.60 to 9.52, p=0.003). Octogenarian patients with colon cancer undergoing major resection with curative intent had a significantly higher 90-day mortality compared to younger patients, though long-term relative survival among 90-day survivors was comparable.
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