Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older

PURPOSE: Because the elderly population in Western countries is rapidly inc reasing, as is their life expectancy, studies aimed at determining the impa ct of major surgery for primary rectal cancer in this group are warranted. The purpose of this study was to compare perioperative morbidity and mortal ity and long-term disease-specific and overall survival in primary rectal c ancer patients, older and younger than 75 years of age, subject to major pe lvic surgery. METHODS: From September 1986 to December 1996, the Prospectiv e Colorectal Service Database identified 1,120 consecutive patients who und erwent major pelvic surgery for primary rectal cancer. Of these, 157 (15 pe rcent) were 75 years of age or older and comprise the elderly group. From t he remaining 963 patients younger than 75 years of age, a representative ra ndom sample of 174 was selected and constitutes the younger group. Data wer e obtained from computerized databases and confirmed via chart review and t elephone interviews. RESULTS: Perioperative complications were observed in 53 (34 percent) elderly and 63 (36 percent; P = not significant) younger pa tients. Perioperative deaths occurred in two (1.3 percent) elderly and one (0.6 percent; P = not significant) younger patient. The median follow-up ti me was 48 months. Although the overall survival was lower in the elderly gr oup (P = 0.02; the 5-year overall survival rates were 51 and 66 percent), t he disease-specific survival rate was similar in the two groups (P = 0.75; the 5-year disease-specific survival rates were 69 and 71 percent). CONCLUS ION: In select individuals 75 years of age or older, major pelvic surgery f or primary rectal cancer can be done with perioperative morbidity and morta lity rates comparable to those obtained in younger individuals, while achie ving excellent disease-specific and overall longterm survival.