Assessment of outcomes after colorectal cancer resection in the elderly as a rationale for screening and early detection

Background: Clinical, social and survival outcomes in elderly patients undergoing bowel cancer surgery were studied to explore the justification for the current upper age limit in colorectal cancer screening programmes. Methods: Scottish national data were analysed to determine age-specific population survival following a diagnosis of colorectal cancer. Detailed analysis of outcome variables was undertaken in a cohort of 180 patients aged over 80 years who underwent resection of colorectal cancer. Results: Population analysis revealed that the absolute risk of developing colorectal cancer was highest in those aged over 80 years, but relative survival was disproportionately poor. Of 180 patients in this age group, 30.0 per cent required an emergency procedure and only 4.6 per cent had Dukes' stage A tumours. Determinants of all-cause mortality were tumour stage (P < 0.001) and degree of co-morbidity (P = 0.004). Some 88.0 per cent of elderly patients returned to the same category of accommodation as that before admission. Conclusion: Colorectal cancer is increasingly common in people aged over 80 years and survival is disproportionately poor compared with that in other age groups. Elective management of early-stage cancer has a better outcome than emergency surgery. The majority of patients maintain social independence. These population and hospital data provide a rationale for early, and even presymptomatic, detection of colorectal cancer in the elderly.