Surgical treatment of gastrointestinal carcinomas in octogenarians: risk factors for complications and long-term outcome

Background: The aims of this retrospective study were to determine the factors predictive of morbidity and mortality, and to evaluate the probability of long-term survival in octogenarians with carcinomas of the gastrointestinal tract. Patients and Methods: Out of a total of 194 patients, aged 80 years or over, with histologically diagnosed carcinoma of the stomach or colon-rectum, observed between 1987 and 1995, 167 underwent surgery and were included in this study. The relationship between a series of clinico-pathological variables and morbidity/mortality rates was investigated by univariate and multivariate analysis. Complete follow-up data were available in 161 patients. Results: Fifty-nine patients (35.3%) experienced complications and 14 (8.4%) died during hospitalization. Statistical analysis identified hypoalbuminaemia (P<0.01, relative risk (RR) = 2.92) and hypercreatininaemia (P<0.05, RR = 3.59) as independent predictors of post-operative complications. Hypercreatininaemia (P<0.05, RR = 5.22) and noncurative surgery (P<0.05, RR = 3.99) significantly affected operative mortality. Crude 5-year survival rate, including operative mortality after curative surgery, was 41% in gastric cancer and 39% in colorectal cancer patients. Conclusion: These results indicate that surgery for gastrointestinal carcinomas yields an acceptable operative risk in octogenarians, and provides good long-term results if oncological radicality can be obtained. Pre-operative evaluation of tumour stage and patient's general condition is useful to identify subgroups of patients at high risk of surgical complications and mortality. (C) 2000 Harcourt Publishers Ltd.