Colorectal cancer in the elderly: Prognostic factors and surgical outcome

Aim: With the diffusion of the Westernized lifestyle the incidence rate of colorectal cancer (CRC) being increased. Age is the most important risk factor for sporadic CRC, being a disease of older individuals predominantly. Almost 70% of colorectal cancer patients are diagnosed at age 65 years and this incidence increases with each succeeding decade thereafter. It clear, then, that the ageing of the population will further increase the number of elderly patients who present with this disease and who will need to be evaluated for surgery. The evaluation of the prognostic factors of colorectal cancer in older patients is a complex matter, since there are interplays between patient-dependent and tumorrelated factors. The aim of our study is to evaluate every possible source of information about the issue of prognostic factors that could lead to a better selection of patients eligible for surgery. Methods. We restricted the review to longitudinal studies of adults undergoing surgery for Dukes stage A-D colon-rectal cancer since 2000 found on the following databases: Medline, Embase, Scopus. We scanned the reference lists of all review articles thus identifying eligible primary studies. Results: Elderly patients are an heterogeneous group. The relation between age and colorectal cancer prognosis is complex and may be biased by differences in stage at presentation, tumor site, comorbidities and property of treatment received. Age is a risk factor for survival because hospital mortality is higher in the elderly. But if the patient survives the operative procedures and the immediate postoperative phase, then the longterm outcome may be comparable with that of their younger counterparts. Surgical strategy in elderly patients must not be changed compared to younger ones. Conclusion. The outcome of major surgery in elderly patients could be similar to that in younger ones if careful selection and appropriate attention is exercised.