Colorectal Cancer in Patients Older than 75 Years of Age

Five hundred and nine patients who underwent surgery for colorectal cancer during 1970-1988 at the First Department of Surgery, Nagasaki University School of Medicine, were studied retrospectively to compare the clinicopathological features in 65 cases older than 75 years of age and 409 ranged from 40 to 75 years of age. Older patients revealed a high frequency of right-sided tumors including the transverse colon (32.3%). The older patient group presented with a fewer Dukes stage D in 3.1% of cases compared with 16.4% of the middle age group with low incidences of hepatic metastasis (p < 0.05), but there were no significant differences in lymph node involvement and peritoneal dissemination. A few vascular invasion was found on histologic examination in the older group, but no significant differences in the frequency of gross appearance, cell differentiaion, lymphatic invasion were observed among two groups. DNA ploidy pattern in the older group was also similar to that in the middle age group. The overall perioperative mortality rate was 1.4% (older: 1.5%; control: 1.5%; not significantly). Curative resection rates were 84.6% in older and 76.0% in middle age patients. Overall 5-year survival rate were 65.4% in older and 54.1% in control group. However, 14.5% of the older patients died from non-cancer related causes. The 5-year survival rate by exclusion of these cases was 72.4% with similar rate of the control group. This study suggests that age should no longer be considered a major risk factor for surgical outcome in colorectal cancer, and that the preoperative indication and careful preoperative assessment including operative risks may improve the patient's survival,