The impact of age on rectal cancer treatment, complications and survival

BMC Cancer

Research

Athanasios Xanthoulis¹  Øystein Høydahl¹  Tom-Harald Edna¹  Birger Henning Endreseth²  Stian Lydersen³ 

[1] Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway;IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway;IKOM Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway;Clinic of surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Regional Centre for Child and Youth Mental Health and Child Welfare – Central Norway, Faculty of Medicine, Department of Mental Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway;

关键词: Rectal cancer;    Elderly;    Treatment;    Survival;    Epidemiology;   

DOI  :  10.1186/s12885-022-10058-9

 received in 2022-07-01, accepted in 2022-09-05,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe number of older patients with rectal cancer is increasing. Treatment outcome discrepancies persist, despite similar treatment guidelines. To offer the oldest patients optimal individually adjusted care, further knowledge is needed regarding treatment strategy and outcome. The present study aimed to evaluate treatment, postoperative complications, and survival in older patients treated for rectal cancer.MethodsThis retrospective study included all 666 patients (n=255 females, n=411 males) treated for rectal cancer at Levanger Hospital during 1980-2016 (n=193 <65 years, n=329 65-79 years, n=144 ≥80 years). We performed logistic regression to analyse associations between complications, 90-day mortality, and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival.ResultsDespite a similar distribution of cancer stages across age-groups, patients aged ≥80 years were treated with a non-curative approach more frequently than younger age groups. Among patients aged ≥80 years, 42% underwent a non-curative treatment approach, compared to 25% of patients aged <65 years, and 25% of patients aged 65-79 years. The 90-day mortality was 15.3% among patients aged ≥80 years, compared to 5.7% among patients aged <65 years, and 9.4% among patients aged 65-79 years.Among 431 (65%) patients treated with a major resection with curative intent, the 90-day mortality was 5.9% among patients aged ≥80 years (n=68), compared to 0.8% among patients aged <65 years (n=126), and 3.8% among patients aged 65-79 years (n=237). The rate of postoperative complications was 47.6%. Pneumonia was the only complication that occurred more frequently in the older patient group. The severity of complications increased with three factors: age, American Society of Anaesthesiologists score, and >400 ml perioperative blood loss. Among patients that survived the first 90 days, the relative long-term survival rates, five-year local recurrence rates, and metastases rates were independent of age.ConclusionPatients aged ≥80 years were less likely to undergo a major resection with curative intent and experienced more severe complications after surgery than patients aged <80 years. When patients aged ≥80 years were treated with a major resection with curative intent, the long-term survival rate was comparable to that of younger patients.

【 授权许可】

CC BY   
© The Author(s) 2022. corrected publication 2023

【 图 表 】

Fig. 2