Should we offer elderly patients the same radical treatment for bowel cancer in their eighties and perhaps nineties? Can this be done safely?

The answer to this question for me for a long time has been yes, but where is the evidence that my belief was correct?

I decided an audit was overdue and with the help of 2 superb young lady doctors (who were my house offices at the time), Sarah Davidson & Sarah Oliver, we embarked on this audit. All credit for the data goes to them and their hard work. We audited patients treated between 2002 & 2004 and found that I treated 165 patients with colorectal cancer during that period (98 Men, 71 Women). Patients were divided into 2 groups; group I were patients 75 years or older, while group II were patients younger than 75 years.

	Group I ≥ 75 years	Group II < 75 years
No.	67 patients (38 M, 29 F)	98 patients (58 M, 40 F)
Age	Median age 82 years (75 - 93) 22 pts (75 - 80 years) 42 pts (≥ 80 - 90 years) 3 pts (≥ 90 years)	Median age 67 years (36 – 74)
Follow-up	The median Follow-up was 22 months (range 6-44)	21.5 months (6-45)

The results are presented in this powerpoint presentation in flash format

We found that

Patients 75 or older tend to be less fitter than younger patients.

62% were ASA 3 & 4 (versus 28% in younger patients)

Nevertheless, high resection rates, is achievable with:

Comparable resection rates 88% (vs. 96%)

Comparable potentially curative resection rates 60% (vs. 66%)

Low morbidity & mortality (4.4%)

Comparable recurrence

Comparable survival benefit in the short term

Standard surgical treatment was feasible in the large majority of patients 75 or older with good results