Department of General, Minimally Invasive and Robotic Surgery, S. Matteo degli Infermi Hospital, Spoleto, Perugia, Italy.
Department of General Surgery, Marche Polytechnic University, Ancona, Italy.
Minerva Surg. 2023 Jun;78(3):267-282. doi: 10.23736/S2724-5691.23.09845-3. Epub 2023 Feb 1.
The burden of rectal cancer in the elderly population continues to increase. The aim of this narrative review is to assess evidence updates on the management of elderly patients with rectal cancer.
The subject of rectal cancer in patients ≥70 years old was divided into different topics and, based on the research items, the literature review searched relevant studies from MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, and EMBASE between January 2000 and November 2022. Systematic reviews with or without meta-analyses, narrative reviews, randomized trials, and non-randomized cohort studies were included.
For the fit elderly patient with preserved sphincter tone, standard-of-care surgical therapy should be pursued, whereas frail patients with more advanced disease could benefit from local excision as a palliative approach in combination with neoadjuvant chemoradiotherapy or more intensive radiotherapy options. Laparoscopic total mesorectal excision is recommended after carefully evaluating the patient's medical history, performance status, and tumor characteristics. Conversely, local excision can be implemented when balancing frailty, oncological outcomes, functional outcomes, and life expectancy. A watch and wait strategy can be considered in selected frail elderly patients with low-rectal tumors in case of complete clinical response after neoadjuvant chemoradiotherapy, with a stringent surveillance protocol, at least in the first three years.
In elderly patients with rectal cancer, the adoption of strategies for patient involvement in healthcare decision-making is essential, as well as the evaluation of the social background and a discussion with the patient about therapeutic modalities.
老年人群中直肠癌的负担持续增加。本叙述性综述旨在评估老年直肠癌患者管理方面的最新证据。
将 70 岁以上患者的直肠癌问题分为不同主题，并根据研究项目，从 2000 年 1 月至 2022 年 11 月，在 MEDLINE（通过 PubMed）、Cochrane 对照试验中心注册库和 EMBASE 中检索相关文献，进行综述。纳入了系统评价（无论是否进行了荟萃分析）、叙述性综述、随机试验和非随机队列研究。
对于保留肛门括约肌张力的健康老年患者，应采用标准护理手术治疗，而疾病进展更严重的虚弱患者可以从局部切除中受益，作为一种姑息性方法，联合新辅助放化疗或更强化放疗选择。在仔细评估患者的病史、身体状况和肿瘤特征后，推荐进行腹腔镜全直肠系膜切除术。相反，在平衡虚弱程度、肿瘤学结果、功能结果和预期寿命的情况下，可以实施局部切除。对于新辅助放化疗后完全临床缓解的低位直肠肿瘤的虚弱老年患者，可以考虑观察等待策略，并制定严格的监测方案，至少在前三年内。
在老年直肠癌患者中，采用患者参与医疗保健决策的策略以及评估社会背景并与患者讨论治疗方式至关重要。
