In both Europe and the United States, approximately 50% of colorectal cancer patients are older than 70 years of age, and, among these, colorectal cancer is the second leading cause of cancer death. Moreover, life expectancy has lengthened in elderly patients.
Surgery is the gold standard for the treatment of colorectal cancer, and it is performed either with curative intent or for problem-solving when patients present with colon perforation or obstruction. These events are characteristic in geriatric age. Elderly patients frequently have one or more comorbidities and are often considered “frail.” For these reasons, they have a very high risk of morbidity and mortality. Comprehensive geriatric assessment (CGA) is a multidimensional tool that accurately predicts postoperative morbidity, in order to assess preoperative risks and to identify elderly colorectal cancer patients who should be given greater attention during pre- and postoperative management.
Nowadays, many studies demonstrate that age alone is not a predictor of postoperative complications. Elderly patients have similar rates of morbidity and mortality as younger patients of the same clinical status. Therefore, it is better to talk about biological age rather than chronological age when assessing risk factors for surgery, which focuses more on the overall condition of the patient.
Despite the fragility of elderly patients and the longer operative times needed to perform laparoscopy, many studies show that laparoscopy and robotic colorectal surgery are safe and good option in elderly patients. Advanced age should not be a contraindication for laparoscopic and robotic colorectal surgery.
Furthermore some studies in the literature have reported that elderly patients undergoing colorectal surgery could benefit from the ERAS protocol and that it improves postoperative outcomes when compared to traditional perioperative management.
In conclusion, age itself is not a risk factor for the development of complications in patients undergoing surgery for colorectal cancer. Age alone should not be a reason to avoid therapeutic or palliative surgery in these patients; instead, patient selection should focus on clinical condition and assessment scores.
Elderly risk assessment Colorectal cancer Laparoscopic colorectal surgery Robotic colorectal surgery ERAS
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