McCarthy K1, Sumrien H1, Burt C1, Dixon A1, Lyons A1, Pullyblank A1, Roe A1, Hughes JL2, Pearce L2 and Hewitt J3*
1Department of General Surgery, North Bristol NHS Trust, UK
2Department of General Surgery, Central Manchester Foundation Trust, UK
3Department of Geriatric Medicine, Cardiff University, UK
Introduction: Sixty percent of all colorectal cancer patients in the UK undergo major surgery. Of these, 22% of patients are aged 80 years or older. Historically there has been a tendency to exclude very old patients from entering clinical trials (not just those within surgery), making evidence based clinical decision making more challenging . It is difficult, therefore, to accurately guide this group of patients who have been assessed as fit for surgery. This is the first study to assess the outcomes for all older patients with colorectal cancer, regardless of whether they underwent surgical intervention or not.Methods: Clinical case notes and electronic patients records were retrospectively reviewed for all patients admitted to North Bristol NHS Trust over a five-year period (January 2009 to February 2014). Patients presenting with a new diagnosis of colorectal cancer were identified. All patients aged 85 years and over were included in the study. Patients were stratified by clinical management strategy i.e. operative or non-operative management of their colorectal cancer. Primary outcome measure was overall survival.
Results: There were 199 patients included in the study, 50.8% (101) were male. Median age of all patients was 88 years (range 85-97 years) and 47% of all patients underwent surgery. More than half (57%) underwent right-sided resections (including hepatic flexure). Overall mean survival for non acute presentations of colorectal cancer were longer in both the operative group and non operative groups (p = 0.007 and p = 0.03 respectively). There was no difference between mean survival in patients presenting as acute surgical emergencies irrespective of operative or non-operative management (p = 0.31).Conclusion: A third of patients with colorectal cancer present as an acute surgical emergency. For this group of patients prognosis is poor and there does not appear to be a survival benefit in undergoing surgical resection.
McCarthy K, Sumrien H, Burt C, Dixon A, Lyons A, Pullyblank A, et al. The Prevalence and Outcomes of Colorectal Cancer Surgery in the Very Elderly. Clin Surg. 2016; 1: 1122.