Retrospective analysis of curative rectal cancer surgery outcomes in elderly patients

Colorectal cancer is the third most common cancer worldwide. Elderly patients, typically defined as those over 70 years, face a heightened risk of developing colorectal cancer as they age, and the proportion of elderly individuals affected by cancer will continue to increase. However, the current guidelines lack optimal treatment recommendations for the elderly and there is a scarcity of clinical trial evidence of clinical trial evidence addressing rectal cancer in this group. Retrospective data was extracted from patients aged 18 and who underwent curative surgery for rectal cancer. A total of 71 patients were included and divided into two groups: an elderly group (EG), comprising patients aged over 70, and a younger group (YG). Age, sex, ASA score, comorbidities, surgical treatments and post-operative morbidity and mortality were extracted from patients 'files. The study population included 55 patients (77.46%) in the YG, and 16 patients (22.54%) in the EG. The cohort consisted of 30 men (42.3%) and 41 women (57.7%), with an average age of 57.1 ± 14.6. Comorbidities were present in 37 patients (52.1%), and 53 patients (74.6%) presented advanced-stage rectal cancer. Of the total cohort, 9 patients underwent primary surgery, while 62patients (87.3%) received neoadjuvant therapy. Laparoscopic surgery was employed in 63 patients (86.6%), with 8 cases (12.69%) of conversion to open surgery. Thirty-seven patients (52.1%) required stomas, of which 11 (16.7%) were definitive. Postoperative morbidity was higher in the EG (50%) compared to the YG (21.81%) with severe complication rate at 12.5% and 7.27%, respectively. Anastomotic leakage rate was similar in both groups (EG = 12.5% vs YG = 3.6.). However, the post-operative mortality rate was significantly higher in the EG (2.81% vs 0%). Within 90 days postoperatively, 6 readmissions were recorded, with a severe morbidity rate (Clavien-Dindo > 2) of 12.3% and a 90-day mortality of 4.2%. Curative surgery for rectal cancer in elderly patients appears to present more difficulties to manage preoperatively, and presents more postoperative mortality, requiring a tailored approach that considers the specific clinical features and functional status of this population.