Colon Cancer Surgical Outcomes in Elderly Improve Interview Invitation
Dorna Jafari, M.D. and

Michael J Stamos, MD
Professor of Surgery
John E. Connolly Chair,
Department of Surgery
University of California, Irvine
Orange, CA 92868 What are the main findings of the study?

Answer: Surgeons are faced with an aging population and data regarding outcomes is rare given that many studies preclude the elderly from the study population. Therefore, it is difficult to accurately discuss risk of surgical resection given the lack of data. Therefore we aimed to report the national trends and outcomes of colorectal cancer treatment in the elderly population.

We demonstrated that the majority of resections are performed in patients >65yeras old. There is a trend towards a decrease in incidence of colorectal resection and a decrease in rate of mortality during 2001-2010.  However, the unique physiological changes associated with aging contribute to increase morbidity and morality as demonstrated by our findings. In fact patients >85 years have a 472% increase in risk-adjusted mortality during a hospital admission compared to younger patients. However, despite the substantially higher mortality and morbidity associated with age, there has been a marked improvement in surgical outcomes in the elderly population. Were any of the findings unexpected?

Answer: We encountered multiple interesting findings including the rate of decrease in surgical resections for colorectal cancer, the improved rates of mortality and substantially higher rates of mortality and complications in the elderly population.

Perhaps the most unexpected finding was that the highest rate of decrease in the number of resections was in the elderly, specifically 7% compared to 2% in the younger population. This would lead us to believe that cancer screening may in fact be contributing to the decreased rate of elderly patients requiring resection compared to younger population.

We also discovered that despite the fact that age independently effected outcomes, over the past 10 years overall mortality rates improved. This improvement was seen mainly in the elderly. In fact as patients aged, the rate of mortality improved. What should clinicians and patients take away from your report?

Answer: We hypothesize that the improvement in mortality is attributable to improved surgical technique and intra-operative and post-operative care of this subset of patients. We believe that given this substantial improvement, we should strive to continue this trend given our aging population. Social factors, increased rates of morbidity and mortality should be addressed with patients so that there are realistic goals and expectations post-operatively. What recommendations do you have for future research as a result of this study?

Answer: This study demonstrates that we have had an overall improvement in mortality; therefore future research should focus on specific areas where further improvements can be made. Given the increased mortality in the elderly and the overall incidence in this population, we should also look into our practices regarding screening in this subgroup and further consider the risk and benefit of continued screening and surgical management based on patient life expectancy. Octogenarians and beyond vary greatly in their physiologic condition and frailty tests have recently been shown to predict outcome and recovery. Further analysis of the elderly based on such an index might allow us to direct resources to the correct subset of the elderly population to garner the greatest rewards in improved outcomes.