RESUMO
OBJECTIVE: to analyse the characteristics of colorectal cancer in elderly patients and to assess the outcomes of treatment. MATERIAL AND METHODS: the study included 1,924 patients diagnosed with colorectal cancer during a 22 year period (1985-2007). We analysed patient clinical and demographic characteristics as well as their treatment and its outcome. RESULTS: there was an increase in emergency surgery with age, increasing from 13% among patients under 80 years of age to 47% in those over 90 years of age (p = 0.0001). On the other hand, the overall percentage of patients who underwent surgical treatment decreased from 96% in patients younger than 80 years of age, to 85% and 59% in octogenarians and nonagenarians, respectively (p = 0.0001), and there was a similar pattern in the rates of curative surgery among patients who underwent surgery. The overall mortality of patients who underwent surgery was 8% (141 out of 1,769), increasing from 4% in patients younger than 70 years of age to 25% in those over 90 (p = 0.0001). Multivariate analysis showed that the factors associated with mortality were the emergency nature of the surgery (p = 0.001), the ASA grade (p = 0.0001), and the presence of systemic complications (p = 0.0001), the weight of age decreasing significantly with respect to the univariate analysis (p = 0.013). CONCLUSIONS: there is an increase in the rate of complicated forms of colorectal cancer with increasing age of patients. In addition, there is a dramatic decrease in the rate of curative tumour resection with increasing age. Intraoperative mortality for colorectal cancer in octogenarians and nonagenarians is more closely related to the nature and intent of the surgery (elective or emergency; palliative or curative), the perioperative risk (ASA grade), and severe systemic complications, than to age.
Assuntos
Neoplasias Colorretais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do TratamentoRESUMO
Objetivo: analizar las características del cáncer colorrectal en pacientes ancianos y evaluar los resultados de su tratamiento. Material y métodos: 1.924 pacientes diagnosticados por cáncer colorrectal un periodo de 22 años (1985-2007). Se analizan parámetros del paciente, clínicos, tratamiento y resultados del mismo. Resultados: hay un incremento de la cirugía de urgencia con la edad, pasando del 13% en pacientes menores de 80 años al 47% en pacientes mayores de 90 (p = 0,0001). El porcentaje de pacientes sometidos a tratamiento quirúrgico desciende del 96% en los pacientes menores de 80 años, al 85% en los octogenarios y al 59% en los nonagenarios (p = 0,0001), así como de la tasas de cirugía curativa entre los pacientes sometidos a tratamiento quirúrgico. La mortalidad global de pacientes sometidos a cirugía ha sido del 8% (141 de 1.769), ascendiendo del 4% en pacientes menores de 70 años al 25% en los de 90 años o más (p = 0,0001). En el análisis multivariante, los factores relacionados con la mortalidad han sido el carácter urgente de la cirugía (p = 0,001), el grado ASA (p = 0,0001), y la presencia de complicaciones sistémicas (p = 0,0001), disminuyendo el peso de la edad de forma significativa (p = 0,013). Conclusiones: hay un incremento de las formas complicadas de presentación del cáncer colorrectal según avanza la edad de los pacientes. Hay un descenso dramático de resección tumoral curativa en relación al incremento de la edad. La mortalidad operatoria por cáncer colorrectal, de pacientes octogenarios y nonagenarios, depende más que de la edad, del carácter electivo o urgente de la cirugía, de que esta sea con intención curativa o paliativa, con el riesgo perianestésico (grado ASA), y con la aparición de complicaciones sistémicas graves(AU)
Objective: to analyse the characteristics of colorectal cancer in elderly patients and to assess the outcomes of treatment. Material and methods: the study included 1,924 patients diagnosed with colorectal cancer during a 22 year period (1985-2007). We analysed patient clinical and demographic characteristics as well as their treatment and its outcome. Results: there was an increase in emergency surgery with age, increasing from 13% among patients under 80 years of age to 47% in those over 90 years of age (p = 0.0001). On the other hand, the overall percentage of patients who underwent surgical treatment decreased from 96% in patients younger than 80 years of age, to 85% and 59% in octogenarians and nonagenarians, respectively (p = 0.0001), and there was a similar pattern in the rates of curative surgery among patients who underwent surgery. The overall mortality of patients who underwent surgery was 8% (141 out of 1,769), increasing from 4% in patients younger than 70 years of age to 25% in those over 90 (p = 0.0001). Multivariate analysis showed that the factors associated with mortality were the emergency nature of the surgery (p = 0.001), the ASA grade (p = 0.0001), and the presence of systemic complications (p = 0.0001), the weight of age decreasing significantly with respect to the univariate analysis (p = 0.013). Conclusions: there is an increase in the rate of complicated forms of colorectal cancer with increasing age of patients. In addition, there is a dramatic decrease in the rate of curative tumour resection with increasing age. Intraoperative mortality for colorectal cancer in octogenarians and nonagenarians is more closely related to the nature and intent of the surgery (elective or emergency; palliative or curative), the perioperative risk (ASA grade), and severe systemic complications, than to age(AU)
