Prognostic value of surgical treatment in elderly patients with ulcerative colitis-associated colorectal cancer: A subanalysis of a nationwide Japanese multicenter study

Aim

Our study aimed to examine the characteristics of elderly patients diagnosed with ulcerative colitis-associated colorectal cancer (UAC) and evaluate the impact of surgical intervention on prognosis.

Methods

A total of 1086 patients diagnosed with UAC between 1980 and 2020 were retrospectively enrolled. Data were collected through the Japanese Society for Cancer of the Colon and Rectum project. The patients were divided into two groups: 248 elderly patients in the E-UAC group and 838 nonelderly patients in the NE-UAC group. Patients aged >65 y at cancer diagnosis were considered elderly.

Results

The recurrence rate did not differ between the two groups. Segmental resection was the only common independent risk factor for recurrence in both the E-UAC and the NE-UAC groups. The E-UAC patients had significantly better 5-y disease-specific survival (DSS) than the NE-UAC patients (94.7% vs 91.0%, p = 0.04). There were no differences in 5-y recurrence-free survival (RFS; 89.3% vs 86.6%, respectively, p = 0.24) or overall survival (OS; 88.8% vs 89.6%, p = 0.50). The E-UAC patients who underwent segmental resection had poorer RFS than those who underwent total proctocolectomy, but there were no significant differences in DSS or OS.

Conclusion

Despite the elevated risk of cancer recurrence observed in the UAC patients who underwent segmental resection in both the E-UAC the NE-UAC groups, our findings suggested that segmental resection may be a viable alternative to total proctocolectomy in terms of survival rate for the E-UAC patients.