Colon-rectum cancer in patients above 70 years of age

Tumors of colin and rectum occur frequently in the geriatric age group. This study was undertaken to analyze over the last 10 years, our operative records of patients over 70 years of age with colon and rectal carcinoma - compared to a similar number of patients under 70 years of age. The analysis of 1000 consecutive major laparotomies in patients above 70 showed that more than 25% (253) were due to tumor of colon and rectum. Macroscopic staging of the lesion revealed that more than 60% were suffering from a highly advanced lesion, and a higher rate of emergency operation 18.6% (acute intestinal obstruction and/or perforation of tumor) was performed in the aged group in comparison to 9% emergency operation in the younger age group. Such data indicate the tendency to delay diagnosis and treatment in the elderly patient. Histological study revealed well differentiated adenocarcinoma in 100% of the lesions - a remarkable characteristic of colon-rectal cancer in the elderly patient. Curative surgery was performed in 68.4% and palliative surgery in 31.6%. The overall mortality in the aged group was 13%, this was 8% in the electively operated patients and above 25% in emergency cases. Other factors resulting in high mortality rate were: presence of liver metastasis; age above 80; patients in vital capacity Cat III; presence of more than one of these factors results in mortality rates above 50%. This should be considered in the decision making process. Early surgery in acute situations, appropriate use of perioperative antibiotics, and the introduction of automatic staplers contribute to lower mortality. Quality of life is a very important consideration in elderly patients, therefore preference should be given to definitive rather than staged procedures, and colostomies, both temporary and definitive should be avoided whenever possible. Further reduction in mortality may be achieved in the elderly patients by earlier diagnosis, thus decreasing the rate of emergency procedures and palliative operations in patients with wide spread metastasis.