Skip to main content

Advertisement

SpringerLink
Log in

Should radical surgery for rectal cancer be offered to elderly population? A propensity-matching analysis on short- and long-term outcomes

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Elderly patients with rectal tumor are often undertreated if compared to younger ones. The reasons for this attitude are not fully clear.The aim of this study was to determine the feasibility of radical treatments for rectal cancer in subjects with an age ≥ 75 years (group 1) and to compare short- and long-term outcomes of these patients with patients with an age of less that 75 years (group 2). 311 consecutive patients who underwent radical surgery for rectal cancer were evaluated. A propensity-matching analysis on short- and long-term outcomes was conducted to compare older and younger patients. Overall postoperative complication rate was 23.8% (19/80) in the group 2 and 33.8% (27/80) in group 1 (p = 0.162). OS at 1, 3 and 5 years was 96.2%, 88.4% and 75.9% in under 75 and 92.5%, 64.3% and 50.6% in over 75 group, respectively (p = 0.001). However, TSS was considered, no significant difference was found. Major complications were comparable within groups: 10 (12.5%) versus 11 (13.8%) in groups 2 and 1, respectively (p = 0.633). This study suggests that major rectal cancer surgery with curative intent should not be denied to an elderly population on the basis of age alone. Specific oncologic features and comorbidities are better long-term mortality predictors than aging.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J et al (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49(6):1374–1403

    Article  CAS  PubMed  Google Scholar 

  2. Rutten HJT, den Dulk M, Lemmens VEPP, van de Velde CJH, Marijnen CAM (2008) Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol 9(5):494–501

    Article  PubMed  Google Scholar 

  3. Day JC (1996) Population projections of the United States, by age, sex, race, and hispanic origin: 1992 to 2050, U.S. Bureau of the Census, Current Population Reports, U.S. Government Printing Office, Washington, DC, pp 25–1130

    Google Scholar 

  4. World Bank life expectancy from birth—Italy. https://data.worldbank.org/country/Italy. Accessed Mar 2017

  5. van Gijn W, Marijnen CAM, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):(6):575–582. https://doi.org/10.1353/mcb.2006.0095

    Article  PubMed  Google Scholar 

  6. Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2006) Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 93(10):(10):1215–1223. https://doi.org/10.1016/j.jdeveco.2008.03.004

    Article  CAS  PubMed  Google Scholar 

  7. Etzioni DA, Liu JH, O’Connell JB, Maggard MA, Ko CY (2003) Elderly patients in surgical workloads: a population-based analysis. Am Surg 69(11):961–965

    PubMed  Google Scholar 

  8. Kwok AC, Semel ME, Lipsitz SR et al (2011) The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet 378(9800):1408–1413

    Article  PubMed  Google Scholar 

  9. Cooper Z, Courtwright A, Karlage A, Gawande A, Block S (2014) Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg 260(6):949–957

    Article  PubMed  Google Scholar 

  10. Jung B, Påhlman L, Johansson R, Nilsson E (2009) Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish rectal cancer registry 1995–2004. BMC Cancer. https://doi.org/10.1186/1471-2407-9-68

    Article  PubMed  PubMed Central  Google Scholar 

  11. Endreseth BH, Romundstad P, Myrvold HE, Bjerkeset T, Wibe A (2006) The Norwegian Rectal Cancer Group. Rectal cancer treatment of the elderly. Colorectal Dis 8(6):471–479

    Article  CAS  PubMed  Google Scholar 

  12. Barrier A, Ferro L, Houry S, Lacaine F, Huguier M (2003) Rectal cancer surgery in patients more than 80 years of age. Am J Surg 185(1):54–57

    Article  PubMed  Google Scholar 

  13. US Preventive Services Task Force (2008) Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 149(9):627–637

    Article  Google Scholar 

  14. Townsley CA, Selby R, Siu LL (2005) Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol 23(13):3112–3124

    Article  PubMed  Google Scholar 

  15. Website. Department of economic and social affairs population division. World population ageing 1950–2050 (UN Website). 2001. https://www.un.org/esa/population/publications/worldageing19502050/. Accessed Sept 10, 2018.

  16. Chesney TR, Pang G, Ahmed N (2018) Caring for older surgical patients: contemporary attitudes, knowledge, practices, and needs of general surgeons and residents. Ann Surg 268(1):77–85

    Article  PubMed  Google Scholar 

  17. Suhool A, Moszkowicz D, Cudennec T et al (2018) Optimal oncologic treatment of rectal cancer in patients over 75 years old: results of a strategy based on oncogeriatric evaluation. J Visc Surg 155(1):17–25

    Article  CAS  PubMed  Google Scholar 

  18. von Elm E, Altman DG, Egger M et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4(10):e296

    Article  Google Scholar 

  19. Burnet NG, Jefferies SJ, Benson RJ, Hunt DP, Treasure FP (2005) Years of life lost (YLL) from cancer is an important measure of population burden—and should be considered when allocating research funds. Br J Cancer 92(2):241–245

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Chang C-M, Yin W-Y, Wei C-K et al (2016) Correction: adjusted age-adjusted Charlson Comorbidity Index Score as a risk measure of perioperative mortality before cancer surgery. PLoS ONE One 11(6):e0157900

    Article  Google Scholar 

  21. Gardner JW, Sanborn JS (1990) Years of Potential Life Lost (YPLL)—what does it measure? Epidemiology 1:322–329

    Article  CAS  PubMed  Google Scholar 

  22. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240(2):205–213

    Article  PubMed  PubMed Central  Google Scholar 

  23. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  24. Quirke P, Steele R, Monson J et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sandini M, Pinotti E, Persico I, Picone D, Bellelli G, Gianotti L (2017) Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open 1(5):128–137

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Manceau G, Karoui M, Werner A, Mortensen NJ, Hannoun L (2012) Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients: a systematic review. Lancet Oncol 13(12):e525–e536

    Article  PubMed  Google Scholar 

  27. Symeonidis D, Christodoulidis G, Koukoulis G, Spyridakis M, Tepetes K (2011) Colorectal cancer surgery in the elderly: limitations and drawbacks. Tech Coloproctol 15(Suppl 1):S47–S50

    Article  PubMed  Google Scholar 

  28. Revenig LM, Canter DJ, Henderson MA et al (2015) Preoperative quantification of perceptions of surgical frailty. J Surg Res 193(2):583–589

    Article  PubMed  Google Scholar 

  29. Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC Jr, Moss M (2013) Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg 206(4):544–550

    Article  PubMed  PubMed Central  Google Scholar 

  30. Famularo S, Di Sandro S, Giani A et al (2019) The impact of age and aging on hepatocarcinoma surgery: short- and long-term outcomes in a multicenter propensity-matched cohort. Liver Int. https://doi.org/10.1111/liv.14075

    Article  PubMed  Google Scholar 

  31. Gardner JW, Sanborn JS (1990) Years of potential life lost (YPLL)—what does it measure? Epidemiology 1(4):322–329

    Article  CAS  PubMed  Google Scholar 

  32. Smith JJ, Lee J, Burke C, Contractor KB, Dawson PM (2002) Major colorectal cancer resection should not be denied to the elderly. Eur J Surg Oncol 28(6):661–666

    Article  CAS  PubMed  Google Scholar 

  33. Colorectal Cancer Collaborative Group (2000) Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 356(9234):968–974

    Article  Google Scholar 

  34. Puig-La Calle J, Quayle J, Thaler HT et al (2000) Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older. Dis Colon Rectum 43(12):1704–1709

    Article  PubMed  Google Scholar 

  35. Neugut AI, Fleischauer AT, Sundararajan V et al (2002) Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly: a population-based study. J Clin Oncol 20(11):2643–2650

    Article  PubMed  Google Scholar 

  36. (2007) Comorbid conditions do not negate the benefit of adjuvant chemotherapy in colon cancer. Nat Clin Pract Oncol 4:679–679. https://doi.org/10.1038/ncponc0970

  37. Papamichael D, Audisio RA, Glimelius B et al (2015) Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 26(3):463–476

    Article  CAS  PubMed  Google Scholar 

  38. Sung S-Y, Jang HS, Kim SH et al (2019) Oncologic outcome and morbidity in the elderly rectal cancer patients after preoperative chemoradiotherapy and total mesorectal excision. Ann Surg 269(1):108–113. https://doi.org/10.1097/sla.0000000000002443

    Article  PubMed  Google Scholar 

  39. Fleshman J, Branda M, Sargent DJ et al (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Stevenson ARL, Solomon MJ, Lumley JW et al (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900, Monza, Italy

    Nicolò Tamini, Alessandro Giani, Simone Famularo, Vittorio Giardini & Luca Gianotti

  2. School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy

    Alessandro Giani, Simone Famularo, Mauro Montuori & Luca Gianotti

Authors
  1. Nicolò Tamini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Giani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Simone Famularo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mauro Montuori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vittorio Giardini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luca Gianotti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicolò Tamini.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The study protocol followed the ethical guidelines of the 1975 Declaration of Helsinki (as revised in Brazil 2013). The local Ethical Committee review of the protocol deemed that formal approval was not required owing to the retrospective, observational, and anonymous nature of this study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (JPG 22 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tamini, N., Giani, A., Famularo, S. et al. Should radical surgery for rectal cancer be offered to elderly population? A propensity-matching analysis on short- and long-term outcomes. Updates Surg 72, 801–809 (2020). https://doi.org/10.1007/s13304-020-00717-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00717-6

Keywords

Search

Navigation