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Palliative Surgical Approaches for Older Patients with Colorectal Cancer

  • Andrew P. ZbarEmail author
  • Riccardo A. Audisio
Chapter

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.

Keywords

Symptom management Palliative surgery Cancer surgery Colorectal cancer Older patients 

References

  1. 1.
    Jernal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer statistics 2003. CA Cancer J Clin. 2003;53:5–26.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 3.
    Leading causes of death in the United States, 1973 vs 1999. J Natl Cancer Inst 2002;94:1742.Google Scholar
  4. 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. 5.
    Yancik R, Havlik RJ, Wesley MN, et al. Cancer and comorbidity in older patients: a descriptive profile. Ann Epidemiol. 1996;6:399–412.PubMedCrossRefGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 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.PubMedCrossRefGoogle Scholar
  8. 8.
    Sekue I, Fukuda X, Kumitoh H, Saijo N. Cancer chemotherapy in the elderly. Jpn J Clin Oncol. 1998;28:463–73.CrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Ficorella C, Cannita K, Ricevuto E. The adjuvant therapy of colonic carcinoma in old age. Minerva Med. 1999;90:232–3.PubMedGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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. 19.
    Colorectal Cancer Collaborative Group. Surgery for colorectal cancer in elderly patients. Lancet. 2000;356:968–74.CrossRefGoogle Scholar
  20. 20.
    Koperna T, Kisser M, Schulz F. Emergency surgery for colon cancer in the aged. Arch Surg. 1997;132:1032–7.PubMedCrossRefGoogle Scholar
  21. 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.PubMedCrossRefGoogle Scholar
  22. 22.
    NHS Executive. Referral guidelines for suspected cancer. Department of Health London 1999; HSC: 241.Google Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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.PubMedCrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 32.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–86.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. 34.
    Audisio RA, van Leeuwen B. When reporting on older patients with cancer, frailty information is needed. Ann Surg Oncol. 2011;18:4–5.PubMedCrossRefGoogle Scholar
  35. 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.PubMedCrossRefGoogle Scholar
  36. 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.PubMedCrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar
  38. 38.
    Martin FC, Brighton P. Frailty: different tools for different purposes? Age Ageing. 2008;37:129–31.PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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.PubMedCrossRefGoogle Scholar
  41. 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.PubMedCrossRefGoogle Scholar
  42. 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.PubMedCrossRefGoogle Scholar
  43. 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.PubMedCrossRefGoogle Scholar
  44. 44.
    Trompetas V. Emergency management of malignant acute left-sided colonic obstruction. Ann R Coll Surg Engl 2008;90:181–6.PubMedCrossRefGoogle Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. 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.PubMedCrossRefGoogle Scholar
  47. 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.PubMedCrossRefGoogle Scholar
  48. 48.
    VanHooft JE, Fockens P, Marinelli AW, et al. Premature closure of the Dutch Stent-in I study. Lancet. 2006;368:1573–4.CrossRefGoogle Scholar
  49. 49.
    Audisio RA, Zbar AP, Johnson FE. Clinical trials for colonic stents. Lancet. 2007;369(9557):188–9.PubMedCrossRefGoogle Scholar
  50. 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.PubMedCrossRefGoogle Scholar
  51. 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.PubMedCrossRefGoogle Scholar
  52. 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.PubMedGoogle Scholar
  53. 53.
    Shankar A, Taylor I. Treatment of colorectal cancer in patients aged over 75. Eur J Surg Oncol. 1998;24:391–5.PubMedCrossRefGoogle Scholar
  54. 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.PubMedGoogle Scholar
  55. 55.
    Au HJ, Mulder KE, Fields AL. Systematic review of management of colorectal cancer in elderly patients. Clin Colorectal Cancer. 2003;3:165–71.PubMedCrossRefGoogle Scholar
  56. 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.PubMedGoogle Scholar
  57. 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.PubMedGoogle Scholar
  58. 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.PubMedGoogle Scholar
  59. 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.PubMedCrossRefGoogle Scholar
  60. 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.PubMedCrossRefGoogle Scholar
  61. 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.PubMedCrossRefGoogle Scholar
  62. 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.PubMedCrossRefGoogle Scholar
  63. 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.PubMedCrossRefGoogle Scholar
  64. 64.
    Fiscon V, Portale G, Migliorini G, Frigo F. Laparoscopic resection of colorectal cancer in elderly patients. Tumori. 2010;96:704–8.PubMedGoogle Scholar
  65. 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.PubMedCrossRefGoogle Scholar
  66. 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.PubMedCrossRefGoogle Scholar
  67. 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.PubMedGoogle Scholar
  68. 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.PubMedCrossRefGoogle Scholar
  69. 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.PubMedCrossRefGoogle Scholar
  70. 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.PubMedGoogle Scholar
  71. 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.PubMedCrossRefGoogle Scholar
  72. 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.PubMedCrossRefGoogle Scholar
  73. 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.PubMedCrossRefGoogle Scholar
  74. 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.PubMedCrossRefGoogle Scholar
  75. 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.PubMedCrossRefGoogle Scholar
  76. 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.PubMedCrossRefGoogle Scholar
  77. 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.PubMedCrossRefGoogle Scholar
  78. 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.CrossRefGoogle Scholar
  79. 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.CrossRefGoogle Scholar
  80. 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.PubMedCrossRefGoogle Scholar
  81. 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.PubMedCrossRefGoogle Scholar
  82. 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.PubMedCrossRefGoogle Scholar
  83. 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.PubMedCrossRefGoogle Scholar
  84. 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.PubMedCrossRefGoogle Scholar
  85. 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.PubMedCrossRefGoogle Scholar
  86. 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.PubMedCrossRefGoogle Scholar
  87. 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.PubMedCrossRefGoogle Scholar
  88. 88.
    Wasserberg N, Kaufman HS. Palliation of colorectal cancer. Surg Oncol. 2007;16:299–310.PubMedCrossRefGoogle Scholar
  89. 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.PubMedCrossRefGoogle Scholar
  90. 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.PubMedCrossRefGoogle Scholar
  91. 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.PubMedCrossRefGoogle Scholar
  92. 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.PubMedCrossRefGoogle Scholar
  93. 93.
    Fazio VW. Indications and surgical alternatives for palliation of rectal cancer. J Gastrointest Surg. 2004;8:262–5.PubMedCrossRefGoogle Scholar
  94. 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.PubMedCrossRefGoogle Scholar
  95. 95.
    Kann BR. Early stomal complications. Clin Colon Rectal Surg. 2008;21:23–30.PubMedCrossRefGoogle Scholar
  96. 96.
    Kimmey MB. Endoscopic methods (other than stents) for palliation of rectal carcinoma. J Gastrointest Surg. 2004;8:270–3.PubMedCrossRefGoogle Scholar
  97. 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.PubMedCrossRefGoogle Scholar
  98. 98.
    Saltz LB. Palliative management of rectal cancer: the roles of chemotherapy and radiation therapy. J Gastrointest Surg. 2004;6:274–6.CrossRefGoogle Scholar
  99. 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.PubMedCrossRefGoogle Scholar
  100. 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.PubMedCrossRefGoogle Scholar
  101. 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.PubMedCrossRefGoogle Scholar
  102. 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.CrossRefGoogle Scholar
  103. 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.PubMedCrossRefGoogle Scholar
  104. 104.
    Tanoue Y, Tanaka N, Nomura Y. Primary site resection is superior for incurable metastatic colorectal cancer. World J Gastroenterol. 2010;29:3561–6.CrossRefGoogle Scholar
  105. 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.PubMedCrossRefGoogle Scholar
  106. 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.PubMedCrossRefGoogle Scholar
  107. 107.
    Ronnekliev-Kelly SM, Kennedy GD. Management of stage IV rectal cancer: palliative options. World J Gastroenterol. 2011;17:835–47.CrossRefGoogle Scholar
  108. 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.CrossRefGoogle Scholar
  109. 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. 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. 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.PubMedCrossRefGoogle Scholar
  112. 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.PubMedCrossRefGoogle Scholar
  113. 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.PubMedCrossRefGoogle Scholar
  114. 114.
    Meulenbeld HJ, Creemers G-J. First-line treatment strategies for elderly patients with metastatic colorectal cancer. Drugs Aging. 2007;24:223–38.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Surgery and TransplantationChaim Sheba Medical CenterTel Hashomer, Ramat Gan, Tel AvivIsrael
  2. 2.Department of SurgerySt. Helens and Knowsley Teaching HospitalsSt Helens, MerseysideUK

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