Outcomes in elderly patients following surgery for colorectaI cancer in the veterans affairs health care system

Abstract

Aim: To compare 30-day and 5-year mortality in elderly vs. younger patients following surgical resection for colorectal cancer. Methods: A cohort study of patients admitted to VA hospitals with a new diagnosis of colorectal cancer who underwent surgical resection between October 1990 and September 2000. Cumulative survival rates (30-day and 5-year) were calculated from Kaplan-Meier estimates and adjusted risks of death were estimated using Cox proportional hazards models. Results: We identified 34 888 individuals with a new diagnosis of colorectal cancer between October 1990 and September 2000, of whom 22 633 (65%) underwent surgical resection. The 30-day mortality following resection for rectal and colon cancer, respectively, for patients <65 years was 2.1 and 2.8% compared with 4.9 and 5.6% for those ≥65 years. The 5-year cumulative survival for rectal and colon cancer for patients <65 years was 54.0 and 57.6% compared with 44.5 and 46.6% for those ≥65 years. In patients ≥65 years with rectal or colon cancer, after adjustment, 30-day mortality was 21/2 times greater and 5-year mortality was 11/2 times greater than in younger patients. Conclusions: Older age is an independent predictor of increased short-term and long-term mortality following surgery in patients with rectal and colon cancer.