Colorectal Surgery in the Elderly
Colorectal cancer is the most common of cancers in patients 70 years and older. Colorectal surgery for cancer is the commonest major surgery performed in this group.
Life expectancy in the western world is increasing and as a result, the percentage of the elderly is rapidly growing. Therefore the medical and societal burdens of colorectal cancer will only increase over the coming decades. Major surgery in elderly patients poses a constant challenge for surgeons and physicians.
Studies show that the behaviour of colorectal cancer changes little with age; therefore age has no effect on the long-term survival of elderly patients with large bowel cancer.
Further studies have shown an increased mortality and mobility in elderly people over 80. An analysis of 28 studies found a lower survival rate amongst the elderly with co-morbidities, advanced cancer or emergency surgery.
A Canadian study compared the outcomes of people over 80 compared to those in their 60’s and found quality of life and function in both groups were similar post-operatively. Thus age alone should not be used as a criterion to determine which patients should be offered colorectal surgery.
The outcomes of colorectal surgery are likely to be better when:
1. The cancer is at an early stage
2. The patient pre-op is functioning at a high level and has good health
3. People with three or more chronic diseases e.g. diabetes, heart disease, rheumatoid arthritis do more poorly
4. The surgery is seen in a positive light, there is a good support network and family history of Longevity
Dr Stephen Fulham
MBBS FRACS DIP CLIN ED