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Eur J Surg Oncol. 2019 Apr 25. pii: S0748-7983(19)30412-3. doi: 10.1016/j.ejso.2019.04.020. [Epub ahead of print]

Postoperative mortality in elderly patients with colorectal cancer: The impact of age, time-trends and competing risks of dying.

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Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands. Electronic address:
Department of Geriatric Medicine, Elisabeth - Tweesteden Hospital, Tilburg, the Netherlands.
Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
Department of Surgery, Elisabeth - Tweesteden Hospital, Tilburg, the Netherlands.
Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands.



Worse prognosis in elderly colorectal cancer (CRC) patients may be cancer or treatment related, or death from other causes. This population-based study aimed to compare survival among non-metastatic CRC patients between age groups and notice time trends in mortality rates.


Primary stage I-III CRC patients who underwent resection between 2008 and 2013 were selected from the Netherlands Cancer Registry. Patients were divided into three equally distributed age groups and a separated group including the oldest old (<65, 65-74, 75-84 and ≥ 85 years). Survival rates were calculated by age groups and tumour localization. Relative excess risks of death, 30-day, 1-year mortality and 1-year excess mortality were calculated.


52296 patients were included. Age-related differences in 5-year overall survival were observed (colon cancer: 82%, 73%, 56% and 35%; rectal cancer: 82%, 74%, 56% and 38%; p < 0.0001). Age-related differences were less prominent in relative survival and disappeared in conditional relative survival (condition of surviving 1 year). Thirty-day mortality rates decreased over time (colon cancer: 4.9%-3.4%; rectal cancer: 3.0%-1.7%); 1-year mortality rates decreased from 11.9% to 9.6% in colon cancer and from 8.0% to 6.4% in rectal cancer. One-year excess mortality increased with age (17.3% and 12.9% in patients with colon or rectal cancer aged ≥85 years).


One-year mortality rates remain high in elderly patients. Age-related differences in survival disappeared after adjustment for expected death from other causes and first-year mortality. Beneficial time trends in 1-year mortality rates underline that survival in elderly after CRC surgery is modifiable.


Colorectal cancer; Elderly; Postoperative mortality; Survival


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