Traitement chirurgical des cancers coliques après 75 ans. Étude d'une série de 240 patients*

Abstract

Surgery for large bowel cancer in patients over 75 years of age. (240 cases).

Aim of the study: The aim of this retrospective study was to report the results of the surgical treatment for large bowel cancer in patients over 75 years of age.

Patients and method: From 1985 to 1996, 240 patients, 114 men and 126 women, aged 75 years or over (mean age: 82, range: 75 to 95 years) underwent surgical treatment for large bowel carcinoma. Tumors were located in the right colon (n=120), left colon (n=100), transverse colon (n=5), or were multiple (n=15). Clinical presentation was failure of general condition (25%), intestinal obstruction (20%), rectal bleeding (20%), abdominal pain (17%). ASA score was I (n=1), II (n=69), III (n=134), or IV (n=36). Emergency surgery was mandatory in 110 cases (43 urgent and 67 delayed procedures) and 130 patients underwent elective surgery. Surgical resection was performed in 221 cases, including 177 cases with curative intent (67%). Surgical procedures included right colectomy (n=119), left colectomy (n=59), transverse colectomy (n=9) or subtotal colectomy (n=31). Histopathological staging was Astler - Coller A (n=8), B (n=116), C (n=54) et D (n=62).

Results: The postoperative course was uneventful in 157 cases (65.4%). Medical complications occurred in 46 patients with 34 deaths; and surgical complications in 39 patients with 20 subsequent reoperations and 15 deaths. The overall postoperative mortality rate was 20.4% (n=49). Postoperative mortality rate was higher after emergency operations (32.7% vs 10%), higher with the level of ASA grading (class II: 8.6%, Class III: 17.1%, Class IV: 38.8%), higher in patients over 90 years (37.4% vs. 19.1%) and in patients wihout surgical resection (42% vs 18.5%). Disease specific 5-year survival rate was 45% and did not differ when compared to patients younger than 75 years (42%, data not reported).

Conclusions: Patients older than 75 years remain a high risk group, specially if operated on emergency. Nevertheless, age is not a limiting factor in the surgical treatment of colon cancer. Prognosis is mostly depending on ASA grading. Colectomy with curative intent has to be performed when possible.