Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95124, Catania, Italy.
Internal Medicine Unit, Muscatello Hospital, 96011, Augusta, Italy.
Updates Surg. 2019 Sep;71(3):411-417. doi: 10.1007/s13304-019-00650-3. Epub 2019 Apr 5.
This review aims to define the most appropriate surgical approach and geriatric evaluation for elderly patients with colorectal cancer (CRC). Surgery represents the main treatment for CRC, but elderly cancer patients still represent a challenge for the surgeon due to frequent comorbidities such as cardiovascular and pulmonary diseases, which increase operative risk as well as the risk of postoperative morbidity and mortality. Cancer patients with comorbidities show lower survival rates and quality of life, together with higher healthcare costs. There is also evidence that patients with comorbidities sometimes receive modified treatment, compromising optimal care. To optimize treatment, the approach to elderly cancer patients needs a multidisciplinary team to assess preoperative conditions, prevent post-surgical complications and improve outcome, especially for frail patients. Laparoscopic surgery for CRC shows a number of advantages compared to conventional surgery such as less postoperative pain, rapid return to prior activities and a decrease in costs. Recent studies confirm that laparoscopic procedures could be performed safely on both older and younger patients with no difference compared with open surgery as regards morbidity or length of hospital stay.
本文旨在为老年结直肠癌（CRC）患者定义最合适的手术方法和老年评估。手术是 CRC 的主要治疗方法，但由于心血管和肺部疾病等常见合并症，老年癌症患者仍然对外科医生构成挑战，这些合并症会增加手术风险以及术后发病率和死亡率的风险。患有合并症的癌症患者的生存率和生活质量较低，同时医疗保健费用也较高。有证据表明，患有合并症的患者有时会接受修改后的治疗，从而影响最佳治疗效果。为了优化治疗，需要一个多学科团队来评估老年癌症患者的术前状况，预防术后并发症并改善治疗效果，特别是对于体弱的患者。与传统手术相比，CRC 的腹腔镜手术具有许多优势，例如术后疼痛较轻、能更快地恢复到术前活动状态以及降低成本。最近的研究证实，腹腔镜手术可以安全地用于年龄较大和较小的患者，与开放手术相比，在发病率或住院时间方面没有差异。
