# Prognostic value of surgical treatment in elderly patients with ulcerative colitis‐associated colorectal cancer: A subanalysis of a nationwide Japanese multicenter study

## TL;DR

This study found that elderly patients with ulcerative colitis-associated colorectal cancer may have similar survival outcomes with less extensive surgery compared to younger patients.

## Contribution

The study identifies that segmental resection can be a viable surgical option for elderly patients with UAC without compromising survival rates.

## Key findings

- Elderly patients with UAC had significantly better 5-year disease-specific survival than nonelderly patients.
- Segmental resection was a common risk factor for recurrence in both elderly and nonelderly UAC patients.
- Elderly patients who underwent segmental resection had poorer recurrence-free survival but no significant differences in disease-specific or overall survival.

## Abstract

Our study aimed to examine the characteristics of elderly patients diagnosed with ulcerative colitis‐associated colorectal cancer (UAC) and evaluate the impact of surgical intervention on prognosis.

A total of 1086 patients diagnosed with UAC between 1980 and 2020 were retrospectively enrolled. Data were collected through the Japanese Society for Cancer of the Colon and Rectum project. The patients were divided into two groups: 248 elderly patients in the E‐UAC group and 838 nonelderly patients in the NE‐UAC group. Patients aged >65 y at cancer diagnosis were considered elderly.

The recurrence rate did not differ between the two groups. Segmental resection was the only common independent risk factor for recurrence in both the E‐UAC and the NE‐UAC groups. The E‐UAC patients had significantly better 5‐y disease‐specific survival (DSS) than the NE‐UAC patients (94.7% vs 91.0%, p = 0.04). There were no differences in 5‐y recurrence‐free survival (RFS; 89.3% vs 86.6%, respectively, p = 0.24) or overall survival (OS; 88.8% vs 89.6%, p = 0.50). The E‐UAC patients who underwent segmental resection had poorer RFS than those who underwent total proctocolectomy, but there were no significant differences in DSS or OS.

Despite the elevated risk of cancer recurrence observed in the UAC patients who underwent segmental resection in both the E‐UAC the NE‐UAC groups, our findings suggested that segmental resection may be a viable alternative to total proctocolectomy in terms of survival rate for the E‐UAC patients.

Our study examined the characteristics of elderly patients diagnosed with ulcerative colitis‐associated colorectal cancer. We showed that factors associated with aggressive tumor characteristics played a significant role in recurrence risk in the nonelderly patients, but not in the elderly patients.