Resectability, operative mortality, and survival of patients in old age with carcinoma of the colon and rectum

From 1950 to 1964 a total of 1,561 patients and from 1965 to 1973 a total of 793 patients with carcinoma of the colon and rectum were treated. Twenty-nine patients had rectal carcinoma and were treated by local extirpation or diathermy destruction from 1950 to 1973. During the years studied the p roportions of patients more than 70 years old increased to 51 per cent (carcinoma of the colon) and 47 per cent (carcinoma of the rectum) From 1965 to 1973 the resectability rates were 62 per cent (carcinoma of the colon) and 64 per cent (carcinoma of the rectum) in elderly patients and 79 and 66 per cent, respectively, in younger patients. In both periods mortality in patients more than 70 years old remained two to three times higher than mortality in younger patients. The previous markedly increased mortality after resection/extirpation of the rectum in patients more than 75 years old decreased significantly from 36 to 15 per cent. Five-year survival in elderly patients discharged from the hospital after resection or extirpation was less than in the young, but comparison with figures for the general population showed reductions in life expectancy of about 40 per cent after carcinoma of the colon and rectum for both young and old patients. Operative mortality after local treatment of rectal carcinoma was low, but we achieved a five-year survival rate of 29 per cent only in patients with tumors of Dukes' type A, less than half the survival rate after radical treatment. It is concluded that local treatment is not a satisfactory alternative to radical treatment, unless we are convinced that major surgery or permanent colostomy will severely reduce the quality of life.