Short-Term Surgical Outcomes and Postoperative Safety in Octogenarian Patients Undergoing Colorectal Cancer Resection: A Comparative Cohort Study

Background: Surgical management of colorectal cancer (CRC) in elderly adults presents complex clinical challenges due to baseline multimorbidity and frailty. This study aimed to evaluate short-term surgical safety and postoperative outcomes in carefully selected octogenarian patients (≥80 years) compared with a younger cohort (<80 years) in a specialized colorectal unit following comprehensive geriatric evaluation, prehabilitation, and standardized minimally invasive surgery. Methods: A retrospective observational cohort study was conducted on 742 consecutive patients undergoing elective curative-intent resection for CRC between 2021 and 2025. Patients were stratified into two cohorts: <80 years (n = 604) and ≥80 years (n = 138). Clinical characteristics, frailty burden evaluated using the clinician-reported IF-VIG index, surgical techniques, histopathological staging, and 30-day postoperative morbidity were evaluated. Multivariable logistic regression was performed to adjust for potential baseline confounders including ASA status, frailty, surgical approach, and tumor stage. Results: Octogenarians exhibited a significantly higher prevalence of baseline frailty (23.2%, 32/138 evaluated vs. 5.8%, 35/605 evaluated, p < 0.001) and ASA physical status grade III–IV (70.3% vs. 45.7%, p < 0.001). Surgical approaches were comparable in both groups (p = 0.560). Overall, minimally invasive surgery rates (laparoscopic and robotic) reached 92.6% in octogenarians and 95.2% in younger controls. Specifically, robotic-assisted resection was implemented at equal rates between groups (71.1% vs. 71.1%). Overall 30-day postoperative complications were comparable (≥80: 42.0% vs. <80: 43.6%, p = 0.731), as were major complications (Clavien–Dindo > II: 9.4% vs. 11.1%, p = 0.572). Among patients undergoing primary intestinal anastomosis (n = 632), anastomotic leakage (3.5% vs. 3.1%, p = 0.835) and anastomotic bleeding (9.6% vs. 9.3%, p = 0.920) showed no significant differences. Multivariable logistic regression confirmed that advanced age ≥ 80 years was not an independent predictor of overall morbidity (aOR 0.92, 95% CI 0.60–1.41, p = 0.698). Median length of hospital stay (4 days, p = 0.391), 30-day readmissions (4.4% vs. 4.3%, p = 0.979), and 30-day in-hospital mortality (0.0% vs. 0.3%, p = 0.499) were equivalent. Conclusions: Elective curative-intent CRC resection in carefully selected octogenarians managed within a multidisciplinary pathway incorporating objective frailty assessment, prehabilitation, and minimally invasive techniques yields short-term postoperative outcomes, major complication rates, and hospital stays comparable to younger counterparts. Advanced chronological age alone should not preclude surgical resection in fit or mild-to-moderately frail older adults.