Skip to main content
SpringerLink
Log in

Palliative Surgical Approaches for Older Patients with Colorectal Cancer

  • Chapter
  • First Online:
Management of Colorectal Cancers in Older People

  • 698 Accesses

Abstract

Colorectal cancer is a condition of increasing age, where up to 40 % of cases present as colorectal emergencies, most notably obstruction and perforation. The adoption of screening programs in this cohort has been shown to slightly reduce these emergency presentations in high-risk cases, although screening in the elderly will have different aims than that of the rest of the population. In older patients, screening will be designed to detect cancers at an earlier stage, where polyp detection will in some cases be less important given the relationship between polyp transformation and the expected lifespan of the patient. In older patients, more palliative resections are performed with less use of adjuvant and neoadjuvant therapies, although there is no current evidence which suggests that the elderly are unsuitable for adjuvant chemotherapies or radiation protocols. A more standardized assessment of attendant comorbidities and an objective expression of a frailty index will assist in defining those patients at perioperative risk and better delineate cases at higher risk of postoperative institutionalization or who require more intensive monitoring and planned intensive care stays. The issue of colonic stenting, either as definitive therapy or as a bridge to surgery, is discussed as it applies to the elderly, suggesting that there is no overall disadvantage with stent use in cancer-specific survival and that there might be substantial cost benefit with a reduced need for stomas, a higher primary anastomosis rate and reduced length of hospital and ICU stay. The adoption of minimally invasive surgery for both colonic and rectal cancer is lagging in the elderly, where initial data suggests that perioperative mortality and morbidity is unaffected by age. Equally, the expansion of hepatic resection in metastatic cases to the elderly shows that detailed patient selection is associated with good outcomes in those over 70 years of age. The question of management of the stage IV case with a minimally symptomatic (or asymptomatic) colorectal primary remains controversial, where data shows that the likelihood of the primary presenting as an emergent surgical problem is low. The use of chemo-immunotherapy and radiation in this group of elderly cases currently is under-represented and needs better definition.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jernal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics 2003. CA Cancer J Clin. 2003;53:5–26.

    Article  Google Scholar 

  2. Davis DL, Dinse GE, Hoel DG. Decreasing cardiovascular disease and increasing cancer among whites in the United States from 1973 through 1987: good news and bad news. JAMA. 1984;271:431–7.

    Article  Google Scholar 

  3. Leading causes of death in the United States, 1973 vs 1999. J Natl Cancer Inst 2002;94:1742.

    Google Scholar 

  4. Gómez Portilla A, Martínez de Lecea C, Cendoya I, Olobarría I, Martin E, Magrach L, Romero E, Cortés J, Muriel J, Márquez A, Kvadatze M. Prevalence and treatment of oncologic disease in the elderly – an impending challenge. Rev Esp Enferm Dis. 2008;11:706–15.

    Google Scholar 

  5. Yancik R, Havlik RJ, Wesley MN, et al. Cancer and comorbidity in older patients: a descriptive profile. Ann Epidemiol. 1996;6:399–412.

    Article  PubMed  CAS  Google Scholar 

  6. Yancik R, Ganz PA, Varricchio CG, Conley B. Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base. J Clin Oncol. 2001;19:1147–51.

    PubMed  CAS  Google Scholar 

  7. Read WL, Tierney RM, Page NC, Costas I, Govindan R, Spitznagel ELJ, Piccirillo JF. Differential prognostic impact of comorbidity. J Clin Oncol. 2004;22:3099–103.

    Article  PubMed  Google Scholar 

  8. Sekue I, Fukuda X, Kumitoh H, Saijo N. Cancer chemotherapy in the elderly. Jpn J Clin Oncol. 1998;28:463–73.

    Article  Google Scholar 

  9. Wasil T, Lichtman SM, Gupta V, Rush S. Radiation therapy in cancer patients 80 years of age or older. Am J Clin Oncol. 2000;23:526–30.

    Article  PubMed  CAS  Google Scholar 

  10. Audisio RA, Bozzetti F, Gennari R, Jaklitsch MT, Koperna T, Longo WE, Wiggers T, Zbar A. The surgical management of elderly cancer patients: recommendations of the SIOG surgical task force. Eur J Cancer. 2004;40:926–38.

    Article  PubMed  CAS  Google Scholar 

  11. Trimble EL, Carter CL, Cain D, Freidlin B, Ungerleider RS, Friedman MA. Representation of older patients in cancer treatment trials. Cancer. 1994;74:2208–14.

    Article  PubMed  CAS  Google Scholar 

  12. 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;23:3112–24.

    Article  PubMed  Google Scholar 

  13. Aapro MS, Köhne CH, Cohen HJ, Extermann M. Never too old? Age should not be a barrier to enrolment in cancer clinical trials. Oncologist. 2005;10:198–204.

    Article  PubMed  Google Scholar 

  14. Ficorella C, Cannita K, Ricevuto E. The adjuvant therapy of colonic carcinoma in old age. Minerva Med. 1999;90:232–3.

    PubMed  CAS  Google Scholar 

  15. Aparicio T, Navazesh A, Boutron I, Bouarioua N, Chosidow D, Mion M, Choudat L, Sobhani I, Mentre F, Soule JC. Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment. Crit Rev Oncol Hematol. 2009;71:249–57.

    Article  PubMed  Google Scholar 

  16. Reddy N, Yu J, Fakih MG. Toxicities and survival among octogenarians and nonagenarians with colorectal cancer treated with chemotherapy or concurrent chemoradiation therapy. Clin Colorectal Cancer. 2007;6:362–6.

    Article  PubMed  CAS  Google Scholar 

  17. Bouvier A-M, Jooste V, Bonnetain F, Cottet V, Bizollon M-H, Bernard M-P, Faivre J. Adjuvant treatments do not alter the quality of life in elderly patients with colorectal cancer: a population-based study. Cancer. 2008;113:879–86.

    Article  PubMed  Google Scholar 

  18. Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD. ACPGBI Colorectal Cancer Study 2002: Part A – unadjusted outcomes. Part B – Risk adjusted outcomes. The ACPGBI colorectal cancer model. www.ncbi.nlm.nih.gov/pmc/articles/PMC1079964

  19. Colorectal Cancer Collaborative Group. Surgery for colorectal cancer in elderly patients. Lancet. 2000;356:968–74.

    Article  Google Scholar 

  20. Koperna T, Kisser M, Schulz F. Emergency surgery for colon cancer in the aged. Arch Surg. 1997;132:1032–7.

    Article  PubMed  CAS  Google Scholar 

  21. Davies RJ, Collins CD, Vickery CJ, Eyre-Brook I, Welbourn R. Reduction in the proportion of patients with colorectal cancer presenting as an emergency following the introduction of fast-track flexible sigmoidoscopy: a three-year prospective observational study. Colorectal Dis. 2004;6:265–7.

    Article  PubMed  CAS  Google Scholar 

  22. NHS Executive. Referral guidelines for suspected cancer. Department of Health London 1999; HSC: 241.

    Google Scholar 

  23. Clark AJ, Stockton D, Elder A, Wilson RG, Dunlop MG. Assessment of outcomes after colorectal cancer resection in the elderly as a rationale for screening and early detection. Br J Surg. 2004;91:1345–51.

    Article  PubMed  CAS  Google Scholar 

  24. Lin OS, Kozarek RA, Schembre DB, Ayub K, Gluck M, Drennan F, Soon M-S, Rabeneck L. Screening colonoscopy in very elderly patients: prevalence of neoplasia and estimated impact on life expectancy. JAMA. 2006;295:2357–65.

    Article  PubMed  CAS  Google Scholar 

  25. The consultant surgeons and pathologists of the Lothian and Borders Health Branch. Lothian and borders large bowel cancer project: immediate outcome after surgery. Br J Surg. 1995;82:888–90.

    Article  Google Scholar 

  26. Hardcastle JD, Chamberlain JO, Robinson MH, Moss SM, Amar SS, Balfour TW, et al. Randomized controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–7.

    Article  PubMed  CAS  Google Scholar 

  27. Clarke GA, Jacobson BC, Hammett RJ, Carr-Locke DL. The indications, utilization and safety of gastrointestinal endoscopy in an extremely elderly patient cohort. Endoscopy. 2001;33:580–4.

    Article  PubMed  CAS  Google Scholar 

  28. Ure T, Dehghan K, Vernava III AM, Longo WE, Andrus CA, Daniel GI. Colonoscopy in the elderly: low risk, high yield. Surg Endosc. 1995;9:505–8.

    PubMed  CAS  Google Scholar 

  29. Maas HA, Janssen-Heijnen ML, Olde-Rikkert MG, et al. Comprehensive geriatric assessment and its clinical impact in oncology. Eur J Cancer. 2007;43:2161–9.

    Article  PubMed  Google Scholar 

  30. Pope D, Ramesh H, Gennari R, et al. Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol. 2006;15:189–97.

    Article  PubMed  CAS  Google Scholar 

  31. PACE participants, Audisio RA, Pope D, Ramesh HS, Gennari R, van Leeuwen BL, West C, Corsini G, Maffezzini M, Hoekstra HJ, Mobarak D, Bozzetti F, Colledan M, Wildiers H, Stotter A, Capewell A, Marshall E. Shall we operate? preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65:156–63.

    Article  PubMed  CAS  Google Scholar 

  32. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.

    Article  PubMed  CAS  Google Scholar 

  33. Mendoza TR, Wang XS, Cleeland CS, et al. The rapid assessment of fatigue severity in cancer patients: use of the brief fatigue inventory. Cancer. 1999;85:1186–96.

    Article  PubMed  CAS  Google Scholar 

  34. Audisio RA, van Leeuwen B. When reporting on older patients with cancer, frailty information is needed. Ann Surg Oncol. 2011;18:4–5.

    Article  PubMed  Google Scholar 

  35. Kristjansson SR, Nesbakken A, Jordhoy MS, Skovlund E, Audisio RA, Johannessen HO, Bakka A, Wyller TB. 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;76:208–17.

    Article  PubMed  Google Scholar 

  36. Kristjansson SR, Farinella E, Gaskell S, Audisio RA. Surgical risk and post-operative complications in older unfit cancer patients. Cancer Treat Rev. 2009;35:499–502.

    Article  PubMed  Google Scholar 

  37. Schuurmans H, Steverink N, Lindenberg S, et al. Old or frail: what tells us more? J Gerontol A Biol Sci Med Sci. 2004;59:M962–5.

    Article  PubMed  Google Scholar 

  38. Martin FC, Brighton P. Frailty: different tools for different purposes? Age Ageing. 2008;37:129–31.

    Article  PubMed  Google Scholar 

  39. Pavlidis TE, Marakis G, Ballas K, et al. Safety of bowel resection for colorectal surgical emergency in the elderly. Colorectal Dis. 2006;8:657–62.

    Article  PubMed  CAS  Google Scholar 

  40. Law WL, Choi HK, Chu KW. Comparison of stenting with emergency surgery as palliative treatment for obstructing primary left-sided colorectal cancer. Br J Surg. 2003;90:1429–33.

    Article  PubMed  CAS  Google Scholar 

  41. Ng KC, Law WL, Lee YM, et al. Self expanding metallic stents as a bridge to surgery versus emergency resection for obstructing left sided colorectal cancer: a case-matched study. J Gastrointest Surg. 2006;10:798–803.

    Article  PubMed  Google Scholar 

  42. Xinopoulos D, Dimitroulopoulos D, Theodosopoulos T, Tsamakidis K, Bitsakou G, Plataniotis G, Gontikakis M, Kontis M, Paraskevas I, Vassilobpoulos P, Paraskevas F. Stenting or stoma creation for patients with inoperable malignant colonic obstructions. Surg Endosc. 2004;18:421–6.

    Article  PubMed  CAS  Google Scholar 

  43. Carne PW, Frye JN, Robertson GM, Frizelle FA. Stents or open operation for palliation of colorectal cancer: a retrospective, cohort study of perioperative outcome and long-term survival. Dis Colon Rectum. 2004;47:1455–61.

    Article  PubMed  Google Scholar 

  44. Trompetas V. Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl 2008;90:181–6.

    Article  PubMed  Google Scholar 

  45. Trompetas V, Saunders M, Gossage J, Anderson H. Shortcomings in colonic stenting to palliate large bowel obstruction from extracolonic malignancies. Int J Colorectal Dis. 2010;25:851–4.

    Article  PubMed  Google Scholar 

  46. Guo MG, Feng Y, Zheng Q, Di JZ, Wang Y, Fan YB, Huang XY. Comparison of self-expanding metal stents and urgent surgery for left-sided malignant colonic obstruction in elderly patients. Dig Dis Sci. 2011;56(9):2706–10. doi:10.1007/s10620-011-1648-4.

    Article  PubMed  Google Scholar 

  47. Selinger CP, Ramesh J, Martin DF. Long-term success of colonic stent insertion is influenced by indication but not by length of stent or site of obstruction. Int J Colorectal Dis. 2011;26:215–8.

    Article  PubMed  Google Scholar 

  48. VanHooft JE, Fockens P, Marinelli AW, et al. Premature closure of the Dutch Stent-in I study. Lancet. 2006;368:1573–4.

    Article  CAS  Google Scholar 

  49. Audisio RA, Zbar AP, Johnson FE. Clinical trials for colonic stents. Lancet. 2007;369(9557):188–9.

    Article  PubMed  Google Scholar 

  50. Targownik LE, Spiegel BM, Sack J, et al. Colonic stent vs. Emergency surgery for management of acute left-sided malignant colonic obstruction: a decision analysis. Gastrointest Endosc. 2004;60:865–74.

    Article  PubMed  Google Scholar 

  51. Tilney HS, Lovegrove RE, Purkayastha S, et al. Comparison of colonic stenting, open surgery for malignant large bowel obstruction. Surg Endosc. 2007;21:225–33.

    Article  PubMed  CAS  Google Scholar 

  52. Saida Y, Sumiyama Y, Nagao J, Uramatsu M. Long-term prognosis of preoperative bridge to surgery expandable metallic stent insertion for obstructive colorectal cancer comparison with emergency operation. Dis Colon Rectum. 2003;46:S44–9.

    PubMed  Google Scholar 

  53. Shankar A, Taylor I. Treatment of colorectal cancer in patients aged over 75. Eur J Surg Oncol. 1998;24:391–5.

    Article  PubMed  CAS  Google Scholar 

  54. Catena F, Pasqualini E, Tonini V, Avanzolini A, Campione O. Emergency surgery of colorectal cancer in patients older than 80 years of age. Ann Ital Chir. 2002;73:173–80.

    PubMed  CAS  Google Scholar 

  55. Au HJ, Mulder KE, Fields AL. Systematic review of management of colorectal cancer in elderly patients. Clin Colorectal Cancer. 2003;3:165–71.

    Article  PubMed  Google Scholar 

  56. Fietkau R, Zettl H, Klöcking S, Kundt G. Incidence, therapy and prognosis of colorectal cancer in different age groups. A population-based cohort study of the Rostock Cancer Registry. Strahlenther Onkol. 2004;180:478–87.

    PubMed  Google Scholar 

  57. Chiappa A, Zbar AP, Bertani E, Biffi R, Luca F, Pace U, Viale G, Pruneri G, Orecchia R, Lazzari R, Biella F, Grassi C, Zampino G, Fazio N, Della Vigna P, Andreoni L, Andreoni B. Surgical treatment of advanced colorectal cancer in the elderly. Chir Ital. 2005;57:589–96.

    PubMed  Google Scholar 

  58. Richter P, Milanowski W, Bucki K, Kubisz A, Nowak W. Age as a prognostic factor in colorectal cancer treatment. Przegl Lek. 2005;62:1440–3.

    PubMed  Google Scholar 

  59. Heriot AG, Tekkis PP, Smith JJ, Cohen CR, Montgomery A, Audisio RA, Thompson MR, Stamatakis JD. Prediction of postoperative mortality in elderly patients with colorectal cancer. Dis Colon Rectum. 2006;49:816–24.

    Article  PubMed  Google Scholar 

  60. Isobe H, Takasu N, Mizutani M, Kimura W. Management of colorectal cancer in elderly patients over 80 years old. Nippon Ronen Igakkai Zasshi. 2007;44:599–605.

    Article  PubMed  Google Scholar 

  61. Basili G, Lorenzetti L, Biondi G, Preziuso E, Angrisano C, Carnesecchi P, Roberto E, Goletti O. Colorectal cancer in the elderly. Is there a role for safe and curative surgery? ANZ J Surg. 2008;78:466–70.

    Article  PubMed  Google Scholar 

  62. Chautard J, Alves A, Zalinski S, Bretagnol F, Valleur P, Panis Y. Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg. 2008;206:255–60.

    Article  PubMed  Google Scholar 

  63. Pinto RA, Ruiz D, Edden Y, Weiss EG, Nogueras JJ, Wexner SD. How reliable is laparoscopic colorectal surgery compared with laparotomy for octogenarians? Surg Endosc. 2011;25:2692–8.

    Article  PubMed  Google Scholar 

  64. Fiscon V, Portale G, Migliorini G, Frigo F. Laparoscopic resection of colorectal cancer in elderly patients. Tumori. 2010;96:704–8.

    PubMed  Google Scholar 

  65. Robinson CN, Balentine CJ, Marshall CL, Wilks JA, Anaya D, Artinyan A, Berger DH, Albo D. Minimally invasive surgery improves short-term outcomes in elderly colorectal cancer patients. J Surg Res. 2011;166:182–8.

    Article  PubMed  Google Scholar 

  66. Verheijen PM, Stevenson AR, Lumley JW, Clark AJ, Stitz RW, Clark DA. Laparoscopic resection of advanced colorectal cancer. Br J Surg. 2011;98:427–30.

    Article  PubMed  CAS  Google Scholar 

  67. Nozaki I, Kubo Y, Kurita A, Ohta K, Aogi K, Tanada M, Takashima S. Laparoscopic colectomy for colorectal cancer patients with previous abdominal surgery. Hepatogastroenterology. 2008;55:943–6.

    PubMed  Google Scholar 

  68. Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW. Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum. 2004;47:1680–5.

    Article  PubMed  Google Scholar 

  69. Bege T, Lelong B, Esterni B, Turrini O, Guiramand J, Francon D, Mokart D, Houvenaeghel G, Giovannini M, Delpero JR. The learning curve for the laparoscopic approach to conservative mesorectal excision for rectal cancer: lessons drawn from a single institution’s experience. Ann Surg. 2010;251:249–53.

    Article  PubMed  Google Scholar 

  70. Del Rio P, Dell’Abate P, Gomes B, Fumagalli M, Papadia C, Coruzzi A, Leonardi F, Pucci F, Sianesi M. Analysis of risk factors for complications in 262 cases of laparoscopic colectomy. Ann Ital Chir. 2010;81:21–30.

    PubMed  Google Scholar 

  71. Akiyoshi T, Kuroyanagi H, Oya M, Konishi T, Fukuda M, Fujimoto Y, Ueno M, Yamaguchi T. Short-term outcomes of laparoscopic rectal surgery for primary rectal cancer in elderly patients: is it safe and beneficial? J Gastrointest Surg. 2009;13:1614–8.

    Article  PubMed  Google Scholar 

  72. Ogiso S, Yamaguchi T, Hata H, Fukuda M, Ikai I, Yamato T, Sakai Y. Evaluation of factors affecting the difficulty of laparoscopic anterior resection for rectal cancer: “narrow pelvis” is not a contraindication. Surg Endosc. 2011;25:1907–12.

    Article  PubMed  Google Scholar 

  73. Kurian A, Suryadevara S, Ramaraju D, Gallagher S, Hofmann M, Kim S, Zebley M, Fassler S. In-hospital and 6-month mortality rates after open elective vs open emergent colectomy in patients older than 80 years. Dis Colon Rectum. 2011;54:467–71.

    Article  PubMed  Google Scholar 

  74. Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum. 2008;51:296–300.

    Article  PubMed  Google Scholar 

  75. Cescon M, Grazzi GL, Del Gaudio M, Ercolani G, Ravaioli M, Nardo B, Cavallari A. Outcome of right hepatectomies in patients older than 70 years. Arch Surg. 2003;138:547–52.

    Article  PubMed  Google Scholar 

  76. Menon KV, Al-Mukhtar A, Aldouri A, Prasad RK, Lodge PA, Toogood GJ. Outcomes after major hepatectomy in elderly patients. J Am Coll Surg. 2006;203:677–83.

    Article  PubMed  Google Scholar 

  77. Mazzoni G, Tocchi A, Miccini M, Betelli E, Cassini D, De Santis M, Colace L, Brozzetti S. Surgical treatment of liver metastases from colorectal cancer in elderly patients. Int J Colorectal Dis. 2007;22:77–83.

    Article  PubMed  Google Scholar 

  78. Figueras J, Ramos E, López-Ben S, Torras J, Albiol M, Llado L, Gonzáles HD, Rafecas A. Surgical treatment of liver metastases from colorectal cancer in elderly patients. When is it worthwhile? Clin Trans Oncol. 2007;9:392–400.

    Article  CAS  Google Scholar 

  79. Di Liguori-Carino N, van Leeuwen BL, Ghaneh P, Wu A, Audisio RA, Poston GJ. Liver resection for colorectal liver metastases in older patients. Crit Rev Oncol Hematol. 2008;67:273–8.

    Article  Google Scholar 

  80. Adam R, Frilling A, Elias D, Laurent C, Ramos E, Capussotti L, Poston GJ, Wicherts DA, de Haas RJ, the Liver/Met Survey Centre. Liver resection of colorectal metastases in elderly patients. Br J Surg. 2010;97:366–76.

    Article  PubMed  CAS  Google Scholar 

  81. Chiappa A, Makuuchi M, Lygidakis NJ, Zbar AP, Chong G, Bertani E, Sitzler PJ, Biffi R, Bianchi PP, Contino G, Misiotano P, Orsi F, Travaini L, Trifiro G, Zampino MG, Fazio N, Goldhirsch A, Andreoni B. The management of colorectal liver metastases: expanding the role of hepatic resection in the age of multimodal therapy. Crit Rev Oncol Hematol. 2009;72(1):65–75.

    Article  PubMed  CAS  Google Scholar 

  82. Mazzoni G, Tocchi A, Miccini M, Bettelli E, Cassin ID, De Santis M, Colace L, Brozzetti S. Surgical treatment for liver metastases from colorectal cancer in elderly patients. Int J Colorectal Dis. 2007;22:77–83.

    Article  PubMed  Google Scholar 

  83. Figueras J, Ramos E, Lopez-Ben S, Torres J, Albiol M, Llado L, Gonzales HD, Rafecas A. Surgical treatment of liver metastases from colorectal carcinoma in elderly patients. When is it worthwhile? Clin Transl Oncol. 2007;9:392–400.

    Article  PubMed  CAS  Google Scholar 

  84. Reddy SK, Barbas AS, Turley RS, Gamblin C, Geller DA, Marsh JW, Tsung A, Clary BM, Lagoo-Deenadayalan S. Major liver resection in elderly liver patients: a multi-institutional analysis. J Am Coll Surg. 2011;212:787–95.

    Article  PubMed  Google Scholar 

  85. Miner TJ, Jaques DP, Tavaf-Motamen H, Schriver CD. Decision making on surgical palliation based on patient outcome data. Am J Surg. 1999;177:150–4.

    Article  PubMed  CAS  Google Scholar 

  86. Liu SK, Church JM, Lavery IC, Fazio VW. Operation in patients with incurable colon cancer – is it worthwhile? Dis Colon Rectum. 1997;40:11–4.

    Article  PubMed  CAS  Google Scholar 

  87. Rosen SA, Buell JF, Yoshida A, Kazsuba S, Hurst R, Michelassi F, Millis JM, Posner MC. Initial presentation with stage IV colorectal cancer: how aggressive should we be? Arch Surg. 2000;135:530–5.

    Article  PubMed  CAS  Google Scholar 

  88. Wasserberg N, Kaufman HS. Palliation of colorectal cancer. Surg Oncol. 2007;16:299–310.

    Article  PubMed  Google Scholar 

  89. Law WL, Chan WF, Lee YM, Chu KW. Non-curative surgery for colorectal cancer: critical appraisal of outcomes. Int J Colorectal Dis. 2004;19:197–202.

    Article  PubMed  Google Scholar 

  90. Phang PT, MacFarlan JK, Taylor RH, Cheifetz R, Davis Nm Hay J, McGregor G, Speers C, Coldman A. Effect of emergent presentation on outcome from rectal cancer management. Am J Surg. 2003;185:450–4.

    Article  PubMed  Google Scholar 

  91. Ptok H, Marusch F, Steinert R, Meyer L, Lippert H, Gastinger I. Incurable stenosing colorectal carcinoma: endoscopic stent implantation or palliative surgery. World J Surg. 2006;30:1481–7.

    Article  PubMed  Google Scholar 

  92. Hünerbein M, Krause M, Moesta KT, Rau B, Schlag PM. Palliation of malignant rectal obstruction with self-expanding metal stents. Surgery. 2005;137:42–7.

    Article  PubMed  Google Scholar 

  93. Fazio VW. Indications and surgical alternatives for palliation of rectal cancer. J Gastrointest Surg. 2004;8:262–5.

    Article  PubMed  Google Scholar 

  94. Scheidbach H, Ptok H, Schubert D, Kose D, Hugel O, Gastinger L, Köckerling F, Lippert H. Palliative stoma creation: comparison of laparoscopic vs. conventional procedures. Langenbecks Arch Surg. 2009;394:371–4.

    Article  PubMed  CAS  Google Scholar 

  95. Kann BR. Early stomal complications. Clin Colon Rectal Surg. 2008;21:23–30.

    Article  PubMed  Google Scholar 

  96. Kimmey MB. Endoscopic methods (other than stents) for palliation of rectal carcinoma. J Gastrointest Surg. 2004;8:270–3.

    Article  PubMed  Google Scholar 

  97. Rao VS, Al-Mukhtar A, Rayan F, Stojkovic S, Moore PJ, Ahmad SM. Endoscopic laser ablation of advanced rectal carcinoma – DGH experience. Colorectal Dis. 2005;7:58–60.

    Article  PubMed  CAS  Google Scholar 

  98. Saltz LB. Palliative management of rectal cancer: the roles of chemotherapy and radiation therapy. J Gastrointest Surg. 2004;6:274–6.

    Article  Google Scholar 

  99. Turler A, Schafer H, Pichlmaier H. Role of transanal endoscopic microsurgery in the palliative treatment of rectal cancer. Scand J Gastroenterol. 1997;32:58–61.

    Article  PubMed  CAS  Google Scholar 

  100. Michel P, Roque I, DiFiore F, Langlkois S, Scott M, Tenière P, Paillot P. Colorectal cancer with non-resectable synchronous metastases: should the primary tumor be resected? Gastroenterol Clin Biol. 2004;28:434–7.

    Article  PubMed  Google Scholar 

  101. Poultsides GA, Servais EL, Saltz LB, Patil S, Kemeny NE, Guillem JG, Weiser M, Temple LK, Wong WD, Paty PB. Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment. J Clin Oncol. 2009;27:3379–84.

    Article  PubMed  Google Scholar 

  102. Tebutt NC, Norman AR, Cunningham D, Hill ME, Tait D, Oates J, Livingston S, Andreyev J. Intestinal complications after chemotherapy for patients with unresected primary colorectal cancer and synchronous metastases. Gut. 2003;52:568–73.

    Article  Google Scholar 

  103. Scoggins CR, Meszoely IM, Blanke CD, Beauchamp RD, Leach SD. Nonoperative management of primary colorectal cancer in patients with stage IV disease. Ann Surg Oncol. 1999;6:651–7.

    Article  PubMed  CAS  Google Scholar 

  104. Tanoue Y, Tanaka N, Nomura Y. Primary site resection is superior for incurable metastatic colorectal cancer. World J Gastroenterol. 2010;29:3561–6.

    Article  Google Scholar 

  105. Soprani KM, Charachon A, Delbaldo C, Vigano L, Luciani A, Cherqui D. Primary chemotherapy with or without colonic stent for management of irresectable stage IV colorectal cancer. Eur J Surg Oncol. 2010;36:58–64.

    Article  PubMed  Google Scholar 

  106. Karoui M, Roudot-Thoraval F, Mesli F, Mitry E, Aparicio T, DesGuetz G, Louvet C, Landi B, Tiret E, Sobhani I. Primary colectomy in patients with stage IV colon cancer and unresectable distant metastases improves overall survival: results of a multicentric study. Dis Colon Rectum. 2011;54:930–8.

    Article  PubMed  Google Scholar 

  107. Ronnekliev-Kelly SM, Kennedy GD. Management of stage IV rectal cancer: palliative options. World J Gastroenterol. 2011;17:835–47.

    Article  Google Scholar 

  108. Kleespies A, Fuessl KE, Seeliger H, Eichhorn ME, Muller MH, Rentsch M, Thasler WE, Angele MK, Kreis ME, Jauch KW. Determinants of morbidity and survival after elective non-curative resection of stage IV colon and rectal cancer. Int J Colorect Dis. 2009;24:1097–9.

    Article  Google Scholar 

  109. Kretzschmar A, Cunningham D, Berry S. Incidence of gastrointestinal perforations and bleeding in patients starting bevacizumab treatment in first-line mCRC without primary tumour resection: preliminary results from the First BEATrial. Paper presented at American Society of Clinical Oncology gastrointestinal symposium 2006.

    Google Scholar 

  110. Sugrue M, Kozloff M, Hainsworth J, Badarinath S, Cohn A, Flynn P, Steis R, Dong W, Sarkar S, Grothey A. Risk factors for gastrointestinal perforations in patients with metastatic colorectal cancer receiving bevacizumab plus chemotherapy. Paper presented at American Society of Clinical Oncology 2006. J Clin Oncol 2006;24(18 Suppl; Abstr 3535).

    Google Scholar 

  111. Karoui M, Koubaa W, Delbaldo C, Charachon A, Laurent A, Piedbois P, Cherqui D, Tran Van Nhieu J. Chemotherapy has also an effect on primary tumor in colon carcinoma. Ann Surg Oncol. 2008;15:3440–6.

    Article  PubMed  CAS  Google Scholar 

  112. Seo GJ, Park JW, Yoo SB, Kim SY, Choi HS, Chang HJ, Shin A, Jeong SY, Kim DY, Oh JH. Intestinal complications after palliative treatment for asymptomatic patients with unresectable stage IV colorectal cancer. J Surg Oncol. 2010;102:94–9.

    Article  PubMed  Google Scholar 

  113. Costi R, Di Mauro D, Veronesi L, Ardizzoni A, Salcuni P, Roncoroni L, Sarli L, Violi V. Elective palliative resection of incurable stage IV colorectal cancer: who really benefits from it? Surg Today. 2011;41:222–9.

    Article  PubMed  Google Scholar 

  114. Meulenbeld HJ, Creemers G-J. First-line treatment strategies for elderly patients with metastatic colorectal cancer. Drugs Aging. 2007;24:223–38.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgery and Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Tel Aviv, 52621, Israel

    Andrew P. Zbar M.D. (Lond), MBBS, FRCS (ED), FRCS (Gen), FRACS, FCCS, FSICCR (Hon)

  2. Department of Surgery, St. Helens and Knowsley Teaching Hospitals, St Helens, Merseyside, WA9 3DA, UK

    Riccardo A. Audisio M.D., FRCS

Authors
  1. Andrew P. Zbar M.D. (Lond), MBBS, FRCS (ED), FRCS (Gen), FRACS, FCCS, FSICCR (Hon)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo A. Audisio M.D., FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew P. Zbar M.D. (Lond), MBBS, FRCS (ED), FRCS (Gen), FRACS, FCCS, FSICCR (Hon) .

Editor information

Editors and Affiliations

  1. Bank of Cyprus Oncology Centre, Acropoleos Avenue, Nicosia, 2006, Cyprus

    Demetris Papamichael

  2. St Helens Teaching Hospital, University of Liverpool, Marshalls Cross Road, St Helens, WA9 3DA, United Kingdom

    Riccardo A. Audisio

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag London

About this chapter

Cite this chapter

Zbar, A.P., Audisio, R.A. (2013). Palliative Surgical Approaches for Older Patients with Colorectal Cancer. In: Papamichael, D., Audisio, R. (eds) Management of Colorectal Cancers in Older People. Springer, London. https://doi.org/10.1007/978-0-85729-984-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-984-0_7

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-983-3

  • Online ISBN: 978-0-85729-984-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation