Outcomes Following Emergency Colorectal Cancer Presentation in the Elderly.

Webster, Peter John; Tavangar Ranjbar, Niloofar; Turner, Jack; El-Sharkawi, Ahmed; Zhou, Grant; Chitsabesan, Praminthra

AIM Colorectal cancer is predominantly a disease of the elderly and up to 30% of these patients will present as an emergency. We compared the outcomes of "elderly" patients presenting to our unit with a colorectal cancer emergency over a 10-year period with those of a "younger" cohort. METHODS A single centre retrospective review of colorectal cancer emergencies between 1st April 2007 and 1st April 2017 was performed. Patients were separated into two cohorts: "young" (<75 years) and "elderly" (≥75 years). Data collected included demographics, disease status, treatment and outcomes. RESULTS A total of 341 patients (<75 yr: n=154; ≥75 yr: n= 187) presented as a colorectal cancer emergency. Significantly fewer "elderly" patients underwent curative surgical procedures (72% vs. 49%, P<0.0001) or received adjuvant chemotherapy (56% vs. 21%, P<0.0001). "Elderly" patients had significantly more post-operative cardio-respiratory complications (7% vs. 36%, P<0.0001), but despite this there was no significant difference in 30-day mortality (7% vs. 12%,), survival rates at 1-year (75% vs. 74%,) or 3-years (56% vs. 49%). Elderly patients treated with best supportive care had a median overall survival of just 62 (range 1-955) days. CONCLUSION Patients ≥75 yr presenting as a colorectal cancer emergency were significantly less likely to undergo emergency curative surgery or receive adjuvant chemotherapy than those <75 yr. However the 30-day mortality, 1-year and 3-year survival rates for patients undergoing curative surgery were comparable.