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.