ABSTRACT
PURPOSE: This study was designed to characterize the presentation, care, and outcomes of persons older than 75 years, compared with persons 50 to 74 years of age, selected for colorectal cancer. METHODS: Patients over the age of 50 years who had surgery for colon or rectal cancer at the Mount Sinai Hospital between 1997 and 2006 were identified. Data were obtained from a colorectal cancer database and from office and hospital records. Patients were assigned to two groups: 50 to 74 years old and 75 years and older. RESULTS: There were 623 patients in the younger group (mean age, 62.6 years) and 275 in the older group (mean age, 81.5 years). The in-hospital mortality rate was 1% in the younger group compared with 4.2% in the older (P = 0.002). The overall five-year survival was 68.7% and 57.3% in the younger and older groups, respectively, whereas colorectal cancer-specific five-year survival was not significantly different (74.0% vs. 74.7%). There were significant differences between the two groups with respect to cancer location, American Society of Anesthesiologists' score, stage, proportion detected by screening, length of stay, and use of chemotherapy. CONCLUSIONS: Long-term colorectal cancer-related outcomes in the older group are similar to the outcomes in younger patients, suggesting that the decision to operate should not be based on age alone.
Subject(s)
Colonic Neoplasms/diagnosis , Colonic Neoplasms/therapy , Rectal Neoplasms/diagnosis , Rectal Neoplasms/therapy , Age Factors , Aged , Aged, 80 and over , Chemotherapy, Adjuvant , Cohort Studies , Colectomy , Colonic Neoplasms/mortality , Female , Humans , Laparoscopy , Male , Middle Aged , Neoplasm Staging , Radiotherapy, Adjuvant , Rectal Neoplasms/mortality , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
PURPOSE: This study was designed to review the clinical and pathologic findings, treatment, and outcomes of patients who have a cancer that complicates perianal Crohn's disease. METHODS: Charts of patients who had documented perianal Crohn's disease and a pathologic diagnosis of anal carcinoma were reviewed. RESULTS: There were 14 patients (6 men; mean age, 49 years) who had evidence of perianal Crohn's disease (mean, 6.9 (range, 1-20) years) before their cancer diagnosis. The diagnosis often was delayed despite increasing pain, multiple biopsies, and imaging studies. Ten patients had preoperative diagnoses of cancer; however, none of the eight magnetic resonance imaging studies were diagnostic. There were 11 adenocarcinomas (8 mucinous or colloid subtypes) and 3 squamous-cell carcinomas. Treatment included abdominoperineal resections plus chemotherapy in 12, and radiation and a defunctioning stoma in 1 patient. Of the 12 who had an abdominoperineal resection, 3 had posterior vaginectomies and rectus flap reconstructions. At last follow-up (mean, 41 (median, 22) months), five patients were alive without disease, five were alive with disease, and four had died. CONCLUSIONS: Physicians should have a high level of suspicion of cancer in patients with longstanding perianal Crohn's disease who have a change in symptoms. In this series, patients who were diagnosed preoperatively and treated with multimodality therapy had better outcomes.
