Age Related Co-Morbidities in Colorectal Cancer Patients: Surgical Problems and Prognostic Impact

Aim: Colorectal Cancer (CRC) incidence increases with aging. The aim of the study was to analyse the relationship between preexisting diseases and other clinicopathological features in elderly population affected by CRC with perioperative surgical outcome and survival. Patients and Method: Between 1999 and 2006 270 consecutive patients were operated on for CRC at our Institute. Clinical, pathological and surgical data in two groups of patients(A <70 years old, n=146; B ≥70 years old, n=124) were compared. Comorbidities, postoperative complications, mortality rate and 5-year survival in both groups of patients were analyzed, with special reference to patients resected with curative intent (R0). Results: An R0 resection was achieved in 112 and 98 patients respectively in group A and B. Following surgical resection, we observed a low rate of postoperative complications with 19 out of 146 (13%) cases in group A and 25 out of 124 (20.2%) in group B (P=0.078). Mortality rate was significantly higher in elderly group with respect to younger group, 4% vs 0% respectively (P=0.020). Regarding hospitalization and other clinical or pathological findings, there were no differences between the two groups. Patients over 70 years have a high rate of cardiovascular pre-existing diseases (P=0.0001). Cardiovascular diseases increased significantly the risk of developing postoperative complications in both groups, while diabetes mellitus and digestive diseases only in younger population. Younger and older patients resected with curative intent (R0) have 76.8% and 56.7% 5-year overall survival rates respectively (P=0.0006). Tumor-related survival rates, on the contrary, were not significantly different between the two groups (85.7% vs 76.1%; P=0.352). Conclusions: In both young and elderly population, comorbidities should be considered a risk factor for postoperative complications. However, postoperative mortality seems to be a prerogative of elderly people, particularly those affected by cardiovascular diseases. High long-term survival rates are observed even in elderly patients, particularly after resective surgery. In elderly patients a careful preoperative evaluation of cardiovascular and pulmonary pre-existing diseases and an adeguate peri- and postoperative management are needed.