Questioning adjuvant therapy and surveillance in octogenarians after right hemicolectomy

Background: As the population ages, more octogenarians are diagnosed with colorectal cancer. Their high comorbidity and mortality risk complicate decisions on adjuvant therapy and surveillance. This study compared outcomes of right hemicolectomy in older versus younger patients and identified predictors of noncancer mortality. Methods: We retrospectively analyzed 400 patients undergoing elective laparoscopic right hemicolectomy for stage I-III right-sided colon cancer at a tertiary center (2017-2024). Patients were stratified by age (<80 vs ≥80 years); those aged ≥70 years were screened for frailty. Outcomes included short-term morbidity, disease-free survival, overall survival, and noncancer mortality. Fine-Gray regression identified predictors of noncancer death. Results: Of 400 patients, 180 (45%) were aged ≥80 years. Octogenarians had higher comorbidity (Age-Adjusted Charlson Comorbidity Index >6 in 68.3% vs 22.3%, P < .001). Laparoscopic surgery was safe across groups, with similar conversion and leak rates but different 90-day mortality (4.4% vs 0%, P = .002). Disease-free survival was comparable (55.2 vs 54.6 months, P = 1.000), but overall survival was lower in older patients (62 vs 91 months, P < .001). Age ≥80 years (subdistribution hazard ratio 4.55, 95% confidence interval 1.63-12.7) and Age-Adjusted Charlson Comorbidity Index >6 (subdistribution hazard ratio 2.45, 95% confidence interval 1.15-6.0) independently predicted noncancer mortality, which reached 40.4% at 5 years in patients aged ≥80 years with high comorbidity. Conclusions: Laparoscopic right hemicolectomy is safe in octogenarians, with recurrence outcomes comparable to younger patients. However, competing noncancer mortality in those with significant comorbidities limits the benefit of adjuvant therapy and intensive surveillance. Postoperative management should be tailored to comorbidity burden rather than age alone.