Outcomes of Colorectal Cancer Surgery in Nonagenarian Patients

The number of surgeries performed in the super-elderly population has increased annually with improvements in medical technology. Recently, the outcomes of colorectal cancer surgery in patients aged > 90 years have been reported. We retrospectively examined 44 nonagenarian patients who had undergone colorectal cancer surgery at our hospital from July 2007 to April 2021. The median age of the patients was 91.0 years (range, 90-97 years) and the male:female ratio was 21:23. The lesion site was C/A/T/D/S/R in 8/11/10/4/7/4 cases, respectively. The ratio of laparotomy to laparoscopic surgery was 10:34, median operation time was 172 min (range, 92-317 min), and median intraoperative bleeding volume was 20 ml (range, 10-302 ml). The dissection range was D1/2/3 in 9/22/13 cases, respectively, and in 79.5% of cases, dissection of D2 or higher could be performed. Clavian-Dindo classification Grade II or higher complications were observed in five cases (11.3%). Recurrence was observed in 6 of 42 cases, excluding 2 cases of stage IV disease (liver: 3 cases, lung: 3 cases, and peritoneal dissemination: 1 case). The median observation period was 30.5 months, and four deaths occurred from primary disease. Examination of factors influencing complications revealed that a history of ischemic heart disease may increase the incidence of complications following surgery. With sufficient preoperative evaluation, colorectal cancer surgery may be performed safely, even in nonagenarian patients.