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World J Gastroenterol. Apr 14, 2014; 20(14): 3762-3777
Published online Apr 14, 2014. doi: 10.3748/wjg.v20.i14.3762
Personalized surgical management of colorectal cancer in elderly population
Giampaolo Ugolini, Federico Ghignone, Davide Zattoni, Giacomo Veronese, Isacco Montroni
Giampaolo Ugolini, Federico Ghignone, Davide Zattoni, Giacomo Veronese, Isacco Montroni, Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, 40138 Bologna, Italy
Author contributions: All authors contributed to the conception and design of the article, review of the literature and writing of the manuscript; all authors participated equally in the critical revision, editing and approval of the final version of the article.
Correspondence to: Giampaolo Ugolini, MD, PhD, Department of Medical and Surgical Sciences, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. ugolini.g@aosp.bo.it
Telephone: +39-51-6363344 Fax: +39-51-301834
Received: September 28, 2013
Revised: December 9, 2013
Accepted: January 3, 2014
Published online: April 14, 2014
Processing time: 197 Days and 14.9 Hours
Abstract

Colorectal cancer (CRC) in the elderly is extremely common but only a few clinicians are familiar with the complexity of issues which present in the geriatric population. In this phase of the life cycle, treatment is frequently suboptimal. Despite the fact that, nowadays, older people tend to be healthier than in previous generations, surgical undertreatment is frequently encountered. On the other hand, surgical overtreatment in the vulnerable or frail patient can lead to unacceptable postoperative outcomes with high mortality or persistent disability. Unfortunately, due to the geriatric patient being traditionally excluded from randomized controlled trials for a variety of factors (heterogeneity, frailty, etc.), there is a dearth of evidence-based clinical guidelines for the management of these patients. The objective of this review was to summarize the most relevant clinical studies available in order to assist clinicians in the management of CRC in the elderly. More than in any other patient group, both surgical and non-surgical management strategies should be carefully individualized in the elderly population affected by CRC. Although cure and sphincter preservation are the primary goals, many other variables need to be taken into account, such as maintenance of cognitive status, independence, life expectancy and quality of life.

Keywords: Elderly; Colorectal cancer; Surgery; Personalized treatment; Geriatric assessment

Core tip: More than 50% of colorectal cancer cases are diagnosed in patients over 70 years of age. As the geriatric patient is traditionally excluded from randomized controlled trials for a variety of factors (heterogeneity, comorbidities, polypharmacy, inability to consent, etc.) there is a dearth of evidence-based clinical guidelines for the management of these patients. Although cure and sphincter preservation are the primary goals, many other variables need to be taken into account, such as the maintenance of cognitive status, independence, life expectancy, and quality of life. Personalized and patient-centered care should be the goal when caring for elderly patients with colorectal cancer.