Should radical surgery for rectal cancer be offered to elderly population? A propensity-matching analysis on short- and
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ORIGINAL ARTICLE
Should radical surgery for rectal cancer be offered to elderly population? A propensity‑matching analysis on short‑ and long‑term outcomes Nicolò Tamini1 · Alessandro Giani1,2 · Simone Famularo1,2 · Mauro Montuori2 · Vittorio Giardini1 · Luca Gianotti1,2 Received: 2 October 2019 / Accepted: 26 January 2020 © Italian Society of Surgery (SIC) 2020
Abstract Elderly patients with rectal tumor are often undertreated if compared to younger ones. The reasons for this attitude are not fully clear.The aim of this study was to determine the feasibility of radical treatments for rectal cancer in subjects with an age ≥ 75 years (group 1) and to compare short- and long-term outcomes of these patients with patients with an age of less that 75 years (group 2). 311 consecutive patients who underwent radical surgery for rectal cancer were evaluated. A propensity-matching analysis on short- and long-term outcomes was conducted to compare older and younger patients. Overall postoperative complication rate was 23.8% (19/80) in the group 2 and 33.8% (27/80) in group 1 (p = 0.162). OS at 1, 3 and 5 years was 96.2%, 88.4% and 75.9% in under 75 and 92.5%, 64.3% and 50.6% in over 75 group, respectively (p = 0.001). However, TSS was considered, no significant difference was found. Major complications were comparable within groups: 10 (12.5%) versus 11 (13.8%) in groups 2 and 1, respectively (p = 0.633). This study suggests that major rectal cancer surgery with curative intent should not be denied to an elderly population on the basis of age alone. Specific oncologic features and comorbidities are better long-term mortality predictors than aging. Keywords Elderly · Aging · Rectal cancer · Surgery
Introduction Colorectal cancer (CRC) is the most frequent malignant tumor, the second most common cause of cancer-related death in Europe [1], and with the highest prevalence of the disease in aged patients [2]. The geriatric population represents one of the fastest growing subsets of the world inhabitants and by 2030, the elderly will represent 20% of the total Manuscript has been presented as poster during European Association of Coloproctology (ESCP) 13th annual meeting in NICE, 26–28 September 2018. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-020-00717-6) contains supplementary material, which is available to authorized users. * Nicolò Tamini [email protected] 1
Department of Surgery, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900 Monza, Italy
School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
2
population [3]. According to the World Bank Open Data, updated in 2016 [4], the life expectancy in Italy is 84.9 years for female, and 80.3 years for male. In the locally advanced rectal cancer, the most effective treatment is the combination of neoadjuvant chemoradiation followed by total mesorectal excision (TME) [5, 6]. In general, older adults have a high burden of surgical diseases, nearly the double in respect to y
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