Surgery for Colorectal Cancer in Older People

Abstract

Life expectancy has been increasing, and an increasing number of older patients are presenting with colorectal cancer. Surgical management of colorectal cancer in these patients poses a unique challenge, requiring a multidisciplinary team approach, as they have more comorbidities and lower functional reserves. An accurate diagnosis, a thorough patient assessment and individualized treatment is crucial in order to achieve the best possible outcome. While the overall postoperative mortality rates were significantly higher in the over 75 age group, it seems that age itself is not a risk factor for surgery. Older patients presented with more locally advanced disease, a factor that increased the overall postoperative mortality. Comorbid conditions increase the risk of postoperative mortality in these patients. When comparing different age groups with similar American Society of Anesthesiologists (ASA) scores, no significant difference was found in postoperative mortality. Laparoscopic surgery was shown to be beneficial for the elderly, with low morbidity and mortality and a shortened hospital stay. Patients with rectal cancer benefit from transanal endoscopic surgery as a primary procedure or as part of a ‘watch and wait’ strategy following neoadjuvant chemoradiotherapy. Early elective surgery and the avoidance of emergency major surgery whenever possible, by for example the use of stents followed by elective resection in cases of colonic obstruction, will help improve outcomes.