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Surgical Treatment of Colorectal Cancer in Older Patients

  • Harm J. T. RuttenEmail author
  • Gerrit-Jan Liefers
  • Valery E. P. P. Lemmens
Chapter

Abstract

Elderly colorectal cancer patients are underrepresented in randomized studies. Despite the fact that modern guidelines are evidence based, they may not be considered validated for the compromised elderly patient. Increasing age and comorbidity decrease the physiological reserves to respond adequately to occurring complications. Acute surgery also is a major challenge for the older colorectal cancer patient. As a result, before counseling an older patient with colon or rectal cancer, a thorough somatic and mental assessment has to be performed in order to give the best treatment advice, considering primarily the patient’s and his or her family’s perspective.

Keywords

Elderly Colorectal cancer Rectal cancer Surgery Frailty Aged Complications Assessment Counseling 

References

  1. 1.
    Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46(4):765–81.PubMedCrossRefGoogle Scholar
  2. 2.
    Quaglia A, Tavilla A, Shack L, Brenner H, Janssen-Heijnen M, Allemani C, et al. The cancer survival gap between elderly and middle-aged patients in Europe is widening. Eur J Cancer. 2009;45(6):1006–16.PubMedCrossRefGoogle Scholar
  3. 3.
    Lemmens V, Steenbergen LV, Janssen-Heijnen M, Martijn H, Rutten H, Coebergh JW. Trends in colorectal cancer in the south of the Netherlands 1975–2007: rectal cancer survival levels with colon cancer survival. Acta Oncol. 2010;49(6):784–96.PubMedCrossRefGoogle Scholar
  4. 4.
    Rutten H, Dulk M, Lemmens V, Nieuwenhuijzen G, Krijnen P, Jansen-Landheer M, et al. Survival of elderly rectal cancer patients not improved: analysis of population based data on the impact of TME surgery. Eur J Cancer. 2007;43(15):2295–300.PubMedCrossRefGoogle Scholar
  5. 5.
    Townsley CA, Selby R, Siu LL. Systematic review of barriers to the recruitment of older patients with cancer onto clinical trials. J Clin Oncol. 2005;23(13):3112–24.PubMedCrossRefGoogle Scholar
  6. 6.
    Zulman DM, Sussman JB, Chen X, Cigolle CT, Blaum CS, Hayward RA. Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med. 2011;26(7):783–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Seymour MT, Thompson LC, Wasan HS, Middleton G, Brewster AE, Shepherd SF, et al. Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial. Lancet. 2011;377(9779):1749–59.PubMedCrossRefGoogle Scholar
  8. 8.
    Fleming FJ, Pahlman L, Monson JR. Neoadjuvant therapy in rectal cancer. Dis Colon Rectum. 2011;54(7):901–12.PubMedCrossRefGoogle Scholar
  9. 9.
    Rutten HJ, den Dulk M, Lemmens VE, van de Velde CJ, Marijnen CA. Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol. 2008;9(5):494–501.PubMedCrossRefGoogle Scholar
  10. 10.
    Tan E, Tilney H, Thompson M, Smith J, Tekkis PP. The United Kingdom National Bowel Cancer Project – epidemiology and surgical risk in the elderly. Eur J Cancer. 2007;43(15):2285–94.PubMedCrossRefGoogle Scholar
  11. 11.
    Heriot AG, Tekkis PP, Smith JJ, Cohen CR, Montgomery A, Audisio RA, et al. Prediction of postoperative mortality in elderly patients with colorectal cancer. Dis Colon Rectum. 2006;49(6):816–24.PubMedCrossRefGoogle Scholar
  12. 12.
    van den Broek CB, Dekker JW, Bastiaannet E, Krijnen P, de Craen AJ, Tollenaar RA, et al. The survival gap between middle-aged and elderly colon cancer patients. Time trends in treatment and survival. Eur J Surg Oncol. 2011;37(10):904–12.PubMedCrossRefGoogle Scholar
  13. 13.
    Lemmens V, van Steenbergen L, Janssen-Heijnen M, Martijn H, Rutten H, Coebergh JW. Trends in colorectal cancer in the south of the Netherlands 1975–2007: rectal cancer survival levels with colon cancer survival. Acta Oncol. 2010;49(6):784–96.PubMedCrossRefGoogle Scholar
  14. 14.
    Rutten H, den Dulk M, Lemmens V, Nieuwenhuijzen G, Krijnen P, Jansen-Landheer M, et al. Survival of elderly rectal cancer patients not improved: analysis of population based data on the impact of TME surgery. Eur J Cancer. 2007;43(15):2295–300.PubMedCrossRefGoogle Scholar
  15. 15.
    Birgisson H, Talback M, Gunnarsson U, Pahlman L, Glimelius B. Improved survival in cancer of the colon and rectum in Sweden. Eur J Surg Oncol. 2005;31(8):845–53.PubMedCrossRefGoogle Scholar
  16. 16.
    Elferink MAG, van Steenbergen LN, Krijnen P, Lemmens VEPP, Rutten HJ, Marijnen CAM, et al. Marked improvements in survival of patients with rectal cancer in the Netherlands following changes in therapy, 1989–2006. Eur J Cancer. 2010;46(8):1421–9.PubMedCrossRefGoogle Scholar
  17. 17.
    de Graaf EJ, Doornebosch PG, Tollenaar RA, Meershoek-Klein KE, de Boer AC, Bekkering FC, et al. Transanal endoscopic microsurgery versus total mesorectal excision of T1 rectal adenocarcinomas with curative intention. Eur J Surg Oncol. 2009;35(12):1280–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Habr-Gama A, Perez RO, Proscurshim I, Campos FG, Nadalin W, Kiss D, et al. Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg. 2006;10(10):1319–28.PubMedCrossRefGoogle Scholar
  19. 19.
    Habr-Gama A, Perez RO, Nadalin W, Sabbaga J, Ribeiro Jr U, Silva E, Sousa Jr AH, et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg. 2004;240(4):711–7.PubMedGoogle Scholar
  20. 20.
    Bokkerink GM, de Graaf EJ, Punt CJ, Nagtegaal ID, Rutten H, Nuyttens JJ, et al. The CARTS study: chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery. BMC Surg. 2011;11(1):34.PubMedCrossRefGoogle Scholar
  21. 21.
    Vuong T, Belliveau PJ, Michel RP, Moftah BA, Parent J, Trudel JL, et al. Conformal preoperative endorectal brachytherapy treatment for locally advanced rectal cancer: early results of a phase I/II study. Dis Colon Rectum. 2002;45(11):1486–93.PubMedCrossRefGoogle Scholar
  22. 22.
    Vuong T, Devic S, Podgorsak E. High dose rate endorectal brachytherapy as a neoadjuvant treatment for patients with resectable rectal cancer. Clin Oncol (R Coll Radiol). 2007;19(9):701–5.CrossRefGoogle Scholar
  23. 23.
    Dekker JW, van den Broek CB, Bastiaannet E, van de Geest LG, Tollenaar RA, Liefers GJ. Importance of the first postoperative year in the prognosis of elderly colorectal cancer patients. Ann Surg Oncol. 2011;18(6):1533–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Gooiker GA, Dekker JW, Bastiaanet E, van der Geest LG, Merkus JW, van de Velde CJ, Tollenaar RA, Liefers GJ. Risk factors for excess mortality in the first year after curative surgery for colorectal cancer. Ann Surg Oncol. Aug;19(8):2428–34. Epub 2012 Mar 7. PubMed PMID: 22396000; PubMed Central PMCID: PMC3404283.Google Scholar
  25. 25.
    Jiang JK, Lan YT, Lin TC, Chen WS, Yang SH, Wang HS, et al. Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome. Dis Colon Rectum. 2008;51(3):306–11.PubMedCrossRefGoogle Scholar
  26. 26.
    Ansaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, Di SS, et al. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg. 2010;5:29.PubMedCrossRefGoogle Scholar
  27. 27.
    Lemmens VE, Janssen-Heijnen ML, Verheij CD, Houterman S, Repelaer van Driel OJ, Coebergh JW. Co-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer. Br J Surg. 2005;92(5):615–23.PubMedCrossRefGoogle Scholar
  28. 28.
    Lemmens VE, Janssen-Heijnen ML, Houterman S, Verheij KD, Martijn H, Poll-Franse L, et al. Which comorbid conditions predict complications after surgery for colorectal cancer? World J Surg. 2007;31(1):192–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Shahir MA, Lemmens VE, van de Poll-Franse LV, Voogd AC, Martijn H, Janssen-Heijnen ML. Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study. Eur J Cancer. 2006;42(17):3015–21.PubMedCrossRefGoogle Scholar
  30. 30.
    van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 2011;12(6):575–82.PubMedCrossRefGoogle Scholar
  31. 31.
    Kristjansson SR, Nesbakken A, Jordhoy MS, Skovlund E, Audisio RA, Johannessen HO, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010;76(3):208–17.PubMedCrossRefGoogle Scholar
  32. 32.
    Papamichael D, Audisio R, Horiot JC, Glimelius B, Sastre J, Mitry E, et al. Treatment of the elderly colorectal cancer patient: SIOG expert recommendations. Ann Oncol. 2009;20(1):5–16.PubMedCrossRefGoogle Scholar
  33. 33.
    Lemmens VE, Bosscha K, van der Schelling G, Brenninkmeijer S, Coebergh JW, de Hingh IH. Improving outcome for patients with pancreatic cancer through centralization. Br J Surg. 2011;98(10):1455–62.PubMedCrossRefGoogle Scholar
  34. 34.
    van de Poll-Franse LV, Lemmens VE, Roukema JA, Coebergh JW, Nieuwenhuijzen GA. Impact of concentration of oesophageal and gastric cardia cancer surgery on long-term population-based survival. Br J Surg. 2011;98(7):956–63.PubMedCrossRefGoogle Scholar
  35. 35.
    van Gastel YR, Lemmens VE, de Hingh IH, Steevens J, Rutten HJ, Nieuwenhuijzen GA, van Dam RM, Siersema PD. Influance of Comorbidity and Age on 1, 2 and 3 Month Postoperative Mortality Rates in gastrointestinal Cancer Patients. Ann Surg Oncol. 2012 Sep 18. [Epub ahead of print] PubMed PMID: 22987098.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Harm J. T. Rutten
    • 1
    Email author
  • Gerrit-Jan Liefers
    • 2
  • Valery E. P. P. Lemmens
    • 3
    • 4
  1. 1.Colorectal SurgeryCatharina Hospital EindhovenEindhoven, Noord BrabantThe Netherlands
  2. 2.Department of SurgeryLeiden University Medical CenterLeidenThe Netherlands
  3. 3.Department of ResearchComprehensive Cancer Centre SouthEindhovenThe Netherlands
  4. 4.Department of Public HealthErasmus University Medical Centre RotterdamRotterdamThe Netherlands

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