Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer

Isacco Montroni*, Giampaolo Ugolini, Nicole M. Saur, Antonino Spinelli, Sid Rostoft, Monica Millan, Albert Wolthuis, Ian R. Daniels, Roel Hompes, Marta Penna, Alois Furst, Demetris Papamichael, Avni M. Desai, Stefano Cascinu, Jean-Pierre Gerard, Arthur Sun Myint, Valery E. P. P. Lemmens, Mariana Berho, Mark Lawler, Nicola De Liguori CarinoFabio Potenti, Oriana Nanni, Mattia Altini, Geerard Beets, Harm Rutten, David Winchester, Steven D. Wexner, Riccardo A. Audisio

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

With an expanding elderly population and median rectal cancer detection age of 70 years, the prevalence of rectal cancer in elderly patients is increasing. Management is based on evidence from younger patients, resulting in substandard treatments and poor outcomes. Modern management of rectal cancer in the elderly demands patient-centered treatment, assessing frailty rather than chronological age. The heterogeneity of this group, combined with the limited available data, impedes drafting evidence based guidelines. Therefore, a multidisciplinary task force convened experts from the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology and the American College Surgeons Commission on Cancer, with the goal of identifying the best practice to promote personalized rectal cancer care in older patients.

A crucial element for personalized care was recognized as the routine screening for frailty and geriatrician involvement and personalized care for frail patients. Careful patient selection and improved surgical and perioperative techniques are responsible for a substantial improvement in rectal cancer outcomes. Therefore, properly selected patients should be considered for surgical resection. Local excision can be utilized when balancing oncologic outcomes, frailty and life expectancy. Watch and wait protocols, in expert hands, are valuable for selected patients and adjuncts can be added to improve complete response rates. Functional recovery and patient-reported outcomes are as important as oncologic-specific outcomes in this age group. The above recommendations and others were made based on the best-available evidence to guide the personalized treatment of elderly patients with rectal cancer. (C) 2018 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Original languageEnglish
Pages (from-to)1685-1702
Number of pages18
JournalEuropean Journal of Surgical Oncology
Volume44
Issue number11
DOIs
Publication statusPublished - Nov 2018

Keywords

  • Rectal cancer
  • Elderly patients
  • Multidisciplinary
  • Frailty
  • Functional recovery
  • Recommendations
  • RANDOMIZED CLINICAL-TRIAL
  • QUALITY-OF-LIFE
  • COLORECTAL LIVER METASTASES
  • TOTAL MESORECTAL EXCISION
  • PHASE-III TRIAL
  • LAPAROSCOPIC-ASSISTED RESECTION
  • ADVERSE POSTOPERATIVE OUTCOMES
  • AVOIDING RADICAL SURGERY
  • X-RAY BRACHYTHERAPY
  • 6-MINUTE WALK TEST

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