Palliative Surgical Approaches for Older Patients with Colorectal Cancer

  • Andrew P. ZbarEmail author
  • Riccardo A. Audisio


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.


Symptom management Palliative surgery Cancer surgery Colorectal cancer Older patients 


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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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