Sultan A, Zakaria Z, Riaz S, Goni MD, Zakaria AD. Perioperative characteristics and outcomes of colorectal cancer in elderly patients. World J Gastrointest Surg 2026; 18(1): 113040 [DOI: 10.4240/wjgs.v18.i1.113040]
Corresponding Author of This Article
Andee Dzulkarnaen Zakaria, MD, Professor, Department of Surgery, School of Medical Sciences & USM Specialist Hospital, Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kubang Kerian 16150, Kelantan, Malaysia. andee@usm.my
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Surgery
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Retrospective Cohort Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 29, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Sultan A, Zakaria Z, Riaz S, Goni MD, Zakaria AD. Perioperative characteristics and outcomes of colorectal cancer in elderly patients. World J Gastrointest Surg 2026; 18(1): 113040 [DOI: 10.4240/wjgs.v18.i1.113040]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 113040 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.113040
Perioperative characteristics and outcomes of colorectal cancer in elderly patients
Abdullah Sultan, Zaidi Zakaria, Samiya Riaz, Mohammed Dauda Goni, Andee Dzulkarnaen Zakaria
Abdullah Sultan, Zaidi Zakaria, Andee Dzulkarnaen Zakaria, Department of Surgery, School of Medical Sciences & USM Specialist Hospital, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
Samiya Riaz, Department of Fundamental Dental and Medical Sciences, Kulliyyah of Dentistry, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
Mohammed Dauda Goni, Faculty of Veterinary Medicine, Universiti Malaysia Kelantan, Kota Bharu 16100, Kelantan, Malaysia
Author contributions: Sultan A, Zakaria Z, Riaz S, Goni MD and Zakaria AD participated in the conception and design of the study, and were involved in the acquisition, analysis, interpretation and verify of data; Sultan A drafted the manuscript; all authors critically reviewed the manuscript, approved the final version, and were responsible for the decision to submit it for publication.
Institutional review board statement: This study was approved by the Jawatankuasa Etika Penyelidikan Manusia-Universiti Sains Malaysia (Approval No. USM/JEPeM/KK/23030212).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors declare no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The corresponding author will provide the data supporting this article upon request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andee Dzulkarnaen Zakaria, MD, Professor, Department of Surgery, School of Medical Sciences & USM Specialist Hospital, Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kubang Kerian 16150, Kelantan, Malaysia. andee@usm.my
Received: August 20, 2025 Revised: October 2, 2025 Accepted: November 25, 2025 Published online: January 27, 2026 Processing time: 156 Days and 6.6 Hours
Abstract
BACKGROUND
Colorectal cancer (CRC) in older adults presents unique management challenges due to age-related physiological changes and comorbidities. However, this demographic is often underrepresented in clinical research.
AIM
To characterise the perioperative features and outcomes of older CRC patients undergoing surgery at a tertiary hospital in Malaysia.
METHODS
A cross-sectional study was conducted using patient records of older individuals (≥ 65 years old) diagnosed with CRC and who underwent surgery at USM Specialist Hospital, Malaysia, between January 2017 and December 2021. Data on patient characteristics, operative details, pathological findings, body mass index (BMI) based on the Asian classification and postoperative outcomes were collected. Statistical analysis employed χ2 and t-tests to determine associations and identify significant predictors.
RESULTS
The study included 98 participants (57.1% males, 82.7% Malay), with the majority aged 65-69 years (44.9%). BMI indicated a significant association with age group (P = 0.023), with obesity more prevalent among individuals aged 70-74 years and 75-79 years. Type of operation (P = 0.046) and PN stage (P = 0.027) were also significantly associated with age group. Adjuvant treatment demonstrated a significant association with recurrence and follow-up (P = 0.006). Multivariate analysis revealed that BMI, ischaemic heart disease, and M stage were statistically significant predictors of patient survival after follow-up. Overweight patients were 11.22 times more likely to survive than those who were underweight [adjusted odds ratio (aOR) = 11.22, P = 0.016], whereas patients with ischaemic heart disease (aOR = 0.07, P = 0.027) or M1 stage disease (aOR = 0.24, P = 0.014) had significantly lower survival odds.
CONCLUSION
BMI, ischaemic heart disease, and metastatic status are critical determinants of survival, highlighting the importance of comprehensive preoperative assessment and individualised management strategies in this vulnerable population. Further larger-scale, longitudinal studies are needed to improve outcomes among older adults with CRC.
Core Tip: This study assessed perioperative outcomes and prognostic factors in 98 older patients with colorectal cancer (CRC; ≥ 65 years) who underwent surgery at a Malaysian tertiary hospital. Body mass index, ischaemic heart disease, and metastatic status (M stage) were identified as significant predictors of survival. Overweight patients showed better survival outcomes, whereas those with ischaemic heart disease or metastasis had poorer outcomes. Our study provides valuable regional insights into perioperative characteristics and prognostic factors in older CRC patients. These findings highlight the importance of comprehensive preoperative assessment and individualised management strategies, as well as the need for larger-scale, longitudinal studies to optimise care and improve outcomes in this vulnerable population.
