TY - JOUR
T1 - Personalized management of elderly patients with rectal cancer
T2 - 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
AU - Montroni, Isacco
AU - Ugolini, Giampaolo
AU - Saur, Nicole M.
AU - Spinelli, Antonino
AU - Rostoft, Sid
AU - Millan, Monica
AU - Wolthuis, Albert
AU - Daniels, Ian R.
AU - Hompes, Roel
AU - Penna, Marta
AU - Furst, Alois
AU - Papamichael, Demetris
AU - Desai, Avni M.
AU - Cascinu, Stefano
AU - Gerard, Jean-Pierre
AU - Myint, Arthur Sun
AU - Lemmens, Valery E. P. P.
AU - Berho, Mariana
AU - Lawler, Mark
AU - Carino, Nicola De Liguori
AU - Potenti, Fabio
AU - Nanni, Oriana
AU - Altini, Mattia
AU - Beets, Geerard
AU - Rutten, Harm
AU - Winchester, David
AU - Wexner, Steven D.
AU - Audisio, Riccardo A.
PY - 2018/11
Y1 - 2018/11
N2 - 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.
AB - 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.
KW - Rectal cancer
KW - Elderly patients
KW - Multidisciplinary
KW - Frailty
KW - Functional recovery
KW - Recommendations
KW - RANDOMIZED CLINICAL-TRIAL
KW - QUALITY-OF-LIFE
KW - COLORECTAL LIVER METASTASES
KW - TOTAL MESORECTAL EXCISION
KW - PHASE-III TRIAL
KW - LAPAROSCOPIC-ASSISTED RESECTION
KW - ADVERSE POSTOPERATIVE OUTCOMES
KW - AVOIDING RADICAL SURGERY
KW - X-RAY BRACHYTHERAPY
KW - 6-MINUTE WALK TEST
U2 - 10.1016/j.ejso.2018.08.003
DO - 10.1016/j.ejso.2018.08.003
M3 - (Systematic) Review article
C2 - 30150158
SN - 0748-7983
VL - 44
SP - 1685
EP - 1702
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 11
ER -