CURATIVE SURGERY FOR COLORECTAL-CANCER - LONG-TERM RESULTS AND LIFE EXPECTANCY IN THE ELDERLY

PURPOSE: The long-term prognosis after curative surgery for colorectal cancer was evaluated in relation to age and Life expectancy as a poss ible basis for assessing the risk to benefit ratios in the elderly. ME THODS: Data relating to 1,256 patients operated on from 1976 to 1994 w ere stored in a computer database prospectively from 1987. Patients we re subdivided into four age groups (A = <60 years; B = 60-69; C = 70-7 9; D = greater than or equal to 80). Distribution of general contraind ications to curative surgery was examined. In the 869 patients who und erwent curative treatment (A = 206; B = 256; C = 289; D = 118), distri bution of tumor stage and elective/emergency surgery and the operative mortality rate were evaluated. Crude and age-corrected survival curve s were calculated in 794 patients. The median crude survival of each g roup was related by gender and tumor stage to demographic life expecta ncy, assuming as ''relative median survival index'' the ratio between the two values. RESULTS: General contraindications to curative surgery increased significantly with age. The operative mortality fate was hi gher in Group D than in Groups A, B, plus C over the total series (P < 0.001) and in both elective (P < 0.001) and emergency surgery (P < 0. 05). Intergroup analysis of long-term survival rates showed significan t differences between ''crude'' (P = 0.0057) but not age-corrected (P = 0.66) curves. The relative median survival index increased with age, up to approximately 1 in the local stages of Groups C and D. CONCLUSI ONS: To evaluate long-term results, elderly patients should be compare d with unaffected, same-age subjects. Because the risks may be very hi gh, the surgical policy in the elderly should be carefully weighed and related to life expectancy and actual results.