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Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish Rectal Cancer Registry 1995-2004
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
2009 (English)In: BMC Cancer, ISSN 1471-2407, E-ISSN 1471-2407, Vol. 9, 68- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Limited information is available regarding the effect of age on choice of surgical and oncological treatment for rectal cancer. The objective of this study was to assess the influence of age on treatment and outcome of rectal cancer. METHODS: We utilized data in the Swedish Rectal Cancer Registry (SRCR) from patients treated for rectal cancer in Sweden in 1995-2004. RESULTS: A total of 15,104 patients with rectal cancer were identified, 42.4% of whom were 75 years or older. Patients > or = 75 years were less likely to have distant metastases than younger patients (14.8% vs. 17.8%, P < 0.001), and underwent abdominal tumor resection less frequently (68.5% vs. 84.4%, P < 0.001). Of 11,725 patients with abdominal tumor resection (anterior resection [AR], abdominoperineal excision [APE], and Hartmann's procedure [HA]), 37.4% were > or = 75 years. Curative surgery was registered for 85.0% of patients > or = 75 years and for 83.9% of patients < 75 years, P = 0.11. Choice of abdominal operation differed significantly between the two age groups for both curative and non-curative surgery, The frequency of APE was similar in both age groups (29.5% vs. 28.6%), but patients > or = 75 years were more likely to have HA (16.9% vs. 4.9%) and less likely to have preoperative radiotherapy (34.3 vs. 67.2%, P < 0.001). The relative survival rate at five years for all patients treated with curative intent was 73% (70-75%) for patients > or = 75 years and 78% (77-79%) for patients < 75 years of age. Local recurrence rate was 9% (8-11%) for older and 8% (7-9%) for younger patients. CONCLUSION: Treatment of rectal cancer is influenced by patient's age. Future studies should include younger and older patients alike to reveal whether or not age-related differences are purposive. Local recurrence following surgery for low tumors and quality of life aspects deserve particular attention.

Place, publisher, year, edition, pages
2009. Vol. 9, 68- p.
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-22053DOI: 10.1186/1471-2407-9-68PubMedID: 19245701OAI: oai:DiVA.org:umu-22053DiVA: diva2:212540
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2017-12-13Bibliographically approved
In thesis
1. On effectiveness in colorectal surgery: mechanical bowel preparation or not in elective colonic surgery and treatment options for elderly patients with rectal cancer
Open this publication in new window or tab >>On effectiveness in colorectal surgery: mechanical bowel preparation or not in elective colonic surgery and treatment options for elderly patients with rectal cancer
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The management of patients undergoing colorectal surgery has changed in recent decades. Efforts have been made to show that perioperative physiological stress to the patient can be minimised with standardised care programmes and thus improve short term outcome after colorectal surgery. Mechanical bowel preparation (MBP), for instance, has been questioned as part of standard management. There are studies highlighting the effect of cancer treatment and its side effects in the elderly, showing that geriatric patients benefit from oncological therapy in much the same way as younger patients. The impact of this information on surgical and oncological practice in Sweden today is not known. To assess the effectiveness of colorectal surgery we need both randomised controlled trials and population-based cohort studies. We have performed a trial on colonic surgery with and without preoperative mechanical bowel preparation, as well as a nation-wide register study comparing treatment and outcome of rectal cancer in two age groups. In a randomised controlled trial 1505 patients from 21 hospitals were randomised to MBP or no-MBP prior to open elective colonic resection. There were no differences in overall complication rates between the groups: cardiovascular 5.1% with MBP vs. 4.6% without MBP; general infection 7.9% vs. 6.8%; and surgical site complications 15.1% vs. 16.1%. The proportion of patients reaching at least one primary endpoint was 24.5% vs. 23.7% respectively. The patients experience of and postoperative recovery after MBP or no-MBP was evaluated in 105 of the patients in the bowel preparation trial at three of the participating hospitals. Sixty-five patients received MBP and 40 patients did not. In the MBP group 52% needed assistance with bowel preparation. Day 4 postoperatively patients in the no-MBP group perceived more discomfort than patients in the MBP group, p<0.05. Bowel emptying occurred significantly earlier in the no-MBP group than in the MBP group, p<0.05.

In an experimental study the effect of MBP on intramucosal bacterial count was evaluated. Macroscopically normal colon mucosa was collected from 37 patients (20 MBP and 17 No-MBP) undergoing elective colorectal surgery at three hospitals. MBP did not influence the median colony count of E. coli, Bacteroides, or total median colony count, information that was previously unknown. These three studies imply that MBP can be omitted before elective colonic resection. In a population-based register study, treatment for rectal cancer in patients ≥ 75 years and those < 75 years was evaluated using data from the Swedish Rectal Cancer Register 1995-2004 (N=15104). This study revealed that preoperative radiotherapy was used less in patients > 75 years. There was also a higher threshold for surgery in this group, and they more often received a permanent stoma compared to younger patients. Outcome in terms of 5-year local recurrence rate and 5-year cancer-specific survival differed very little between the older and younger patient groups who underwent abdominal tumour resection with curative intent. We suggest future studies focusing on ways of reducing surgical and perioperative stress and on quality of life when assessing suitable treatment modalities for rectal cancer.

Place, publisher, year, edition, pages
Umeå: Kirurgisk och perioperativ vetenskap, 2008. 74 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1176
Keyword
colorectal surgery, bowel preparation, postoperative outcome, quality of life, cancer survival
National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-1633 (URN)978-91-7264-561-5 (ISBN)
Public defence
2008-05-16, Sal B, 1D, Norrlands universitetssjukhus, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2008-05-02 Created: 2008-05-02 Last updated: 2015-09-01Bibliographically approved

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