Surgery for colorectal cancer in elderly patients: a systematic review

Background The effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to producti ve lives, with an improved postoperative life expectancy, or at least one t hat is not diminished by the surgery. Because colorectal cancer is a major cause of morbidity and mortality in elderly people, we have examined how th e outcomes of surgery in elderly patients differ from those in younger pati ents. Methods We did a systematic review of published and aggregate data provided by investigators. Studies were identified by computerised and manual searc hes of published and unpublished reports, scanning references, and contacti ng investigators. Within each study, outcomes for patients aged 65-74 years , 75-84 years, and 85+ years were expressed in relation to those aged less than 65 years. Findings From 28 independent studies, and a total of 34 194 patients, we fo und that elderly patients had an increased frequency of comorbid conditions , were more likely to present with later-stage disease and undergo emergenc y surgery, and less likely to have curative surgery than younger patients. The incidence of postoperative morbidity and mortality increased progressiv ely with advancing age. Overall survival was reduced in elderly patients, b ut for cancer specific survival age-related differences were much less stri king. Interpretation The relation between age and outcomes from colorectal cancer surgery is complex and may be confounded by differences in stage at presen tation, tumour site, pre-existing comorbidities, and type of treatment rece ived. However, selected elderly patients benefit from surgery since a large proportion survive for 2 or more years, irrespective of their age.