Key result
Among octogenarian patients with colon cancer undergoing major resection with curative intent, 100-day mortality was 10.1%, but the five-year relative survival rate for those surviving 100 days was 99.7%.
Why the study?
Few studies have addressed colon cancer surgery outcomes in an unselected cohort of octogenarian patients.
Does major resection with curative intent yield comparable long-term survival in octogenarian patients with colon cancer compared to younger patients?
Cohort (n=1,530)
No
Does major resection with curative intent yield comparable long-term survival in octogenarian patients with colon cancer compared to younger patients?
Octogenarian patients undergoing curative colon cancer resection face high 100-day mortality, but those who survive this period have long-term relative survival comparable to younger patients.
May inform shared decision-making on curative resection in octogenarians; leaves open whether perioperative optimization improves short-term survival.
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 100-day mortality and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival. Results Among 239 octogenarian patients treated with major resections with curative intent, the 100-day mortality was 10.1%. Among 215 patients that survived the first 100 days, the five-year relative survival rate was 99.7%. The 100-day mortality of octogenarian patients was significantly shorter 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 100-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 100‑day and long-term survival rates improved over time. Conclusion Among octogenarian patients with colon cancer that underwent major resections with curative intent, the 100-day mortality was high, but after surviving 100 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 100-day mortality risk.
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Høydahl et al. (2021) conducted a cohort in Colon cancer (n=1,530). Octogenarian age (80-89 years) vs. Younger patients (<80 years) was evaluated on 100-day mortality in octogenarian patients treated with major resections with curative intent. Among octogenarian patients with colon cancer undergoing major resection with curative intent, 100-day mortality was 10.1%, but the five-year relative survival rate for those surviving 100 days was 99.7%.
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