老年学と老年医学の研究

概要

Endoscopic Detection and Surgical Treatment of Colorectal Cancer in Octogenarians

Gianluca Pellino, Guido Sciaudone, Giuseppe Candilio, Gilda Serena De Fatico, Isabella Landino, Silvestro Canonico and Francesco Selvaggi

Background: Colorectal Cancer (CRC) in the elderly is being diagnosed and treated more frequently, as a consequence of longer life expectancy. However, patients aged over 80 years are diagnosed late and surgical treatment is often difficult or aimed to palliate symptoms. Aim of the present study was to report on the characteristics of elderly patients referred to the endoscopy of our surgical Unit and outcomes of surgical treatment compared with younger patients.

Materials and Methods: We prospectively gathered data of all patients referred to our Unit between January 2011 and January 2013 for suspicion of CRC, confirmed during endoscopy. We collected baseline characteristics, management, survival and quality of life (QoL). Patients who received radical surgery were compared with a sex- and disease cohort of younger patients undergoing surgery for CRC in the same period. Presentation and outcomes were compared, as well as survival and QoL. QoL was evaluated in all patients 3 months after endoscopy by means of EORTC QLQ-C30.

Results: Twenty patients aged over 80 years received CRC diagnosis during endoscopy. Most patients were referred to endoscopy because of rectal bleeding (35%). Cancers were mainly located below the splenic flexure (75%), but the rate of right localizations was not negligible. Three (15%) patients received palliative surgery while 4 (20%) refused to undergo surgery or did not meet surgical criteria. At a mean follow-up of 14 ± 6 months survival rate was significantly higher in patients receiving radical surgery (p=0.04). Thirty patients aged < 80 years served as controls. No differences were observed in terms of cancer localization and stage, although elderly patients were more often found with node-positive CRC. Elderly patients more frequently suffered from minor perioperative complications (46.1 vs 6.7% p=0.006), but perioperative mortality and overall survival did not differ between groups. Concerning QoL, radical surgery conferred optimal results when compared with palliative/no surgery, irrespective of age.

Conclusions: Referral of elderly patients to endoscopic examination is often delayed, and may result in suboptimal treatment. Pancolonoscopy and radical surgery should be encouraged, as a timely approach offers excellent results in terms of survival and QoL.