Astrid Lièvre1, Valérie Laurent2, Tristan Cudennec3, Frédérique Peschaud4, Robert Malafosse5, Stéphane Benoist6, Christophe Penna6, Céline Lepère7, Jean-Nicolas Vaillant7, Catherine Julié8, Laurent Teillet9, Bernard Nordlinger4, Philippe Rougier7, Emmanuel Mitry10. 1. Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France. Electronic address: astrid.lievre@curie.fr. 2. AP-HP, Kremblin-Bicêtre Hospital, Department of Hepato-Gastroenterology and Digestive Oncology, Le Kremlin Bicêtre, France. 3. AP-HP, Ambroise Paré Hospital, Department of Geriatrics, Boulogne-Billancourt, France. 4. University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France; AP-HP, Ambroise Paré Hospital, Department of Digestive Surgery and Surgical Oncology, Boulogne-Billancourt, France. 5. AP-HP, Ambroise Paré Hospital, Department of Digestive Surgery and Surgical Oncology, Boulogne-Billancourt, France. 6. AP-HP, Kremlin-Bicêtre Hospital, Department of Digestive Surgery and Surgical Oncology, Le Kremlin Bicêtre, France. 7. AP-HP, Department of Hepato-gastroenterology and Digestive Oncology, Georges Pompidou European Hospital, Paris, France. 8. University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France; AP-HP, Ambroise Paré Hospital, Department of Pathology, Boulogne-Billancourt, France. 9. University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France; AP-HP, Ambroise Paré Hospital, Department of Geriatrics, Boulogne-Billancourt, France. 10. Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France.
Abstract
BACKGROUND: Few data are available on management of very elderly colon cancer patients, especially concerning the parameters of therapeutic decisions and the role of geriatricians. METHODS: We retrospectively reviewed the charts of patients over 80 years of age who underwent surgery for a localised colon cancer in a French academic hospital. RESULTS: A total of 176 patients underwent surgery (postoperative morbidity and mortality rates: 25% and 6.7%). Adjuvant chemotherapy was discussed at a multidisciplinary team meeting for 91% of stage III patients, but only 13.5% of them were treated. Twenty-five patients relapsed: 19 were discussed at the multidisciplinary meeting and 16 were treated (5 had a metastasectomy). Despite their increase with time, geriatric assessments were infrequent, 17% (33% after 2006), and had no impact on postoperative morbi-mortality. Median overall survival and recurrence-free survival were 65.3 months and 65.1 months, respectively. Age, emergency surgery, and Charlson comorbidity index were independent prognostic factors. CONCLUSION: Selected elderly colon cancer patients have significant access to surgery. However, postoperative morbi-mortality rates remain high and adjuvant chemotherapy rarely prescribed. Perioperative geriatric assessment, especially before surgery, should be routinely proposed to these patients to evaluate its impact on postoperative morbi-mortality and prescription of adjuvant treatment.
BACKGROUND: Few data are available on management of very elderly colon cancerpatients, especially concerning the parameters of therapeutic decisions and the role of geriatricians. METHODS: We retrospectively reviewed the charts of patients over 80 years of age who underwent surgery for a localised colon cancer in a French academic hospital. RESULTS: A total of 176 patients underwent surgery (postoperative morbidity and mortality rates: 25% and 6.7%). Adjuvant chemotherapy was discussed at a multidisciplinary team meeting for 91% of stage III patients, but only 13.5% of them were treated. Twenty-five patients relapsed: 19 were discussed at the multidisciplinary meeting and 16 were treated (5 had a metastasectomy). Despite their increase with time, geriatric assessments were infrequent, 17% (33% after 2006), and had no impact on postoperative morbi-mortality. Median overall survival and recurrence-free survival were 65.3 months and 65.1 months, respectively. Age, emergency surgery, and Charlson comorbidity index were independent prognostic factors. CONCLUSION: Selected elderly colon cancerpatients have significant access to surgery. However, postoperative morbi-mortality rates remain high and adjuvant chemotherapy rarely prescribed. Perioperative geriatric assessment, especially before surgery, should be routinely proposed to these patients to evaluate its impact on postoperative morbi-mortality and prescription of adjuvant treatment.