Introduction
The elderly population is increasing worldwide. In Australia, people over the age of 65 makes up 15% of the population while those aged over 85 make up 2.1% of the population1. Colorectal cancer is a leading cause of morbidity and mortality in the western world with incidence rates steadily increasing in the elderly.
Historically, there was an adopted view amongst clinicians that the peri-operative risks were too high for those at the extremes of age, with older patients being offered less aggressive and palliative oncological treatments2. However, evidence is starting to favour surgical intervention for colorectal cancer3in select patients at the extremes of age. Previous studies have investigated the outcomes of colorectal resection in different age ranges (over 75’s, over 80’s ect) and demonstrated favourable results, however there is a paucity of information on the role of colorectal cancer resection specifically in those over 85 (commonly referred to as “the oldest old”)4.
The question of laparoscopic surgery vs open surgery in the elderly population has also been explored with several randomised control trials demonstrating favourable outcomes in ‘elderly patients’5,6. Once again, many of these studies focus on patients in the 6th and 7th decade of life, with a scarcity of studies investigating laparoscopic outcomes in those over 85 7,8.
In order to compare the short-term outcomes from surgery, post-operative complications must be assessed and compared. In previous studies, there has been a lack of consistency in grading complications. Terms such as ‘mild’, ‘moderate’ and ‘severe’ have been inconsistently used and compared, leading to bias. The Clavien-Dindo classification of post-operative complications has been shown to provide a reproducible and objective classification of post-surgical outcomes. The classification is based upon the severity and required treatment for each complication grade and is graded from grade I-V with Grade V being mortality, the gravest of complications. The classifications have been widely used to standardise outcomes in a variety of surgical subspecialties 9-11.
The aim of this study is two-fold: to investigate the short-term outcomes of patients over the age of 85 undergoing colorectal cancer resection and the use of laparoscopic colorectal cancer resection in those over the age of 85.