Format

Send to

Choose Destination
Eur J Surg Oncol. 2018 Nov;44(11):1685-1702. doi: 10.1016/j.ejso.2018.08.003. Epub 2018 Aug 15.

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.

Author information

1
Colorectal Surgery, Department of Surgery, Ospedale per gli Infermi, Viale Stradone 9, 48018 Faenza, Italy. Electronic address: isacmontroni@yahoo.com.
2
Colorectal Surgery, Department of Surgery, Ospedale per gli Infermi Faenza, Viale Stradone 9, 48018 Faenza, Italy; University of Bologna, Bologna, Italy.
3
Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.
4
Colon and Rectal Surgery, Humanitas Research Hospital, Humanitas University, Rozzano-Milano, Italy.
5
Department of Geriatric Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
6
Coloproctology Unit, Department of General and Digestive Surgery, Joan XXIII University Hospital, Tarragona, Spain.
7
Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
8
Exeter Surgical Health Services Research Unit, Royal Devon & Exeter Hospital, Exeter, UK.
9
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
10
Department of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
11
Klinik für Allgemein, Viszeral, Thoraxchirurgie, Adipositasmedizin, Caritas-Krankenhaus St. Josef, Regensburg, Germany.
12
Department of Medical Oncology, BOC Oncology Centre, Nicosia 2006, Cyprus.
13
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
14
Department of Medical and Surgical Sciences for Children and Adults, Division of Oncology, University-Hospital of Modena and Reggio Emilia, Modena, Italy.
15
Centre Antoine Lacassagne, Department of Radiation Oncology, Nice Sophia-Antipolis University, France.
16
Clatterbridge Cancer Centre, Liverpool, UK.
17
Department of Public Health, Erasmus MC Medical Center Rotterdam, The Netherlands; Department of Research, Comprehensive Cancer Organisation the Netherlands, Utrecht, The Netherlands.
18
Cleveland Clinic Florida, Department of Pathology, Weston FL, USA.
19
Centre for Cancer Research and Cell Biology, Queen's University Belfast UK, European Cancer Concord, Leeds, UK and European Cancer Patient Coalition, UK.
20
HPB Unit, Manchester Royal Infirmary, Central Manchester University Hospitals Manchester, UK.
21
Cleveland Clinic Florida, Department of Colorectal Surgery, Weston FL, USA.
22
Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
23
Healthcare Administration, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
24
The Netherlands Cancer Institute, Amsterdam, The Netherlands and GROW School for Oncology and Developmental Biology, University of Maastricht, The Netherlands.
25
Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands and GROW School of Oncology and Developmental Biology, University of Maastricht, The Netherlands.
26
National Cancer Programs, National Accreditation Program for Rectal Cancer (NAPRC) American College of Surgeons Chicago, IL, USA.
27
Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden.

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.

KEYWORDS:

Elderly patients; Frailty; Functional recovery; Multidisciplinary; Recommendations; Rectal cancer

PMID:
30150158
DOI:
10.1016/j.ejso.2018.08.003
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center