Significance of Total Colonoscopy Based on the Outcome of Advanced Colorectal Cancer in Older Individuals

Document Type : Research Articles

Authors

1 Department of Gastroenterology and Hepatology, Faculty of Medicine, Toho University, Tokyo, Japan.

2 Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan.

Abstract

Background: With the increase in Japan’s aging population, the number of total colonoscopies (TCS) performed in individuals aged over 80 years is rising. However, TCS carries an increased risk of complications in older individuals, raising concerns about its utility in this population. This study aimed to evaluate the clinical value of TCS in older individuals diagnosed with advanced colorectal cancer (CRC) at our institution. Materials and Methods: We conducted a retrospective review of patients aged ≥80 years who underwent TCS between January 2010 and December 2021. Patients diagnosed with advanced CRC were categorized into symptomatic and asymptomatic groups based on the presence or absence of symptoms. The groups were compared in terms of clinical characteristics, pathological features, and long-term outcomes. Results: Among 4,130 older patients who underwent TCS, 297 (7.2%) were diagnosed with advanced CRC. Of these, 221 (74%) were symptomatic, and 76 (26%) were asymptomatic. Compared with symptomatic patients, asymptomatic patients had significantly higher body mass index (23.6 vs. 21.5 kg/m²), serum albumin levels (3.7 vs. 3.5 g/dL), and lower carcinoembryonic antigen (CEA; 3.9 vs. 5.6 ng/mL) and carbohydrate antigen 19-9 (CA19-9; 13.4 vs. 19.7 U/mL) levels (all p<0.05). The asymptomatic group also had a higher rate of early-stage disease (68.4% vs. 36.2%) and a greater history of prior TCS (21.1% vs. 5.4%, p<0.001). Five-year overall and disease-specific survival rates were significantly higher in the asymptomatic group (68.3% and 88.3%, respectively) compared to the symptomatic group (38.7% and 65.5%) (p<0.001). No severe complications, such as perforation, were observed. Conclusion: TCS facilitates early detection and improves prognosis in older patients with advanced CRC, supporting its use in appropriately selected individuals.

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Asian Pacific Journal of Cancer Prevention
Volume 27, Issue 1
January 2026
Pages 175-181

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History

  • Receive Date: 28 May 2025
  • Revise Date: 10 September 2025
  • Accept Date: 15 January 2026

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