Surgical treatment of gastrointestinal carcinomas in octogenarians: risk factors for complications and long-term outcome

Background: The aims of this retrospective study were to determine the fact ors predictive of morbidity and mortality, and to evaluate the probability of long-term survival in octogenarians with carcinomas of the gastrointesti nal tract. Patients and Methods: Out of a total of 194 patients, aged 80 years or over , with histologically diagnosed carcinoma of the stomach or colon-rectum, o bserved between 1987 and 1995, 167 underwent surgery and were included in t his study. The relationship between a series of clinico-pathological variab les and morbidity/mortality rates was investigated by univariate and multiv ariate analysis. Complete follow-up data were available in 161 patients. Results: Fifty-nine patients (35.3%) experienced complications and 14 (8.4% ) died during hospitalization. Statistical analysis identified hypoalbumina emia (P<0.01, relative risk (RR) = 2.92) and hypercreatininaemia (P<0.05, R R = 3.59) as independent predictors of post-operative complications. Hyperc reatininaemia (P<0.05, RR = 5.22) and noncurative surgery (P<0.05, RR = 3.9 9) significantly affected operative mortality. Crude 5-year survival rate, including operative mortality after curative surgery, was 41% in gastric ca ncer and 39% in colorectal cancer patients. Conclusion: These results indicate that surgery for gastrointestinal carcin omas yields an acceptable operative risk in octogenarians, and provides goo d long-term results if oncological radicality can be obtained. Pre-operativ e evaluation of tumour stage and patient's general condition is useful to i dentify subgroups of patients at high risk of surgical complications and mo rtality. (C) 2000 Harcourt Publishers Ltd.