Skip to main content
SpringerLink
Log in

Medical and Surgical Management of Colorectal Cancer Emergencies in Elderly Patients

  • Chapter
  • First Online:
Emergency Surgical Management of Colorectal Cancer

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

  • 758 Accesses

Abstract

The incidence of CRC increases sharply with age. Complicated CRC is a predominant disease in elderly patients. Emergency presentation in the elderly is associated with higher rates of advanced disease. Risk of emergency admission is closely linked to advanced age, comorbidities, and well-identified socioeconomic factors. Colorectal resection for CRC in the elderly is a procedure that is frequently performed in an emergency situation and with important pre-existing comorbidity and reduced physiologic reserve. Complicated right-sided colon cancer is the most frequent indication for nonelective colorectal resection in the octogenarian. Frequently, in the setting of obstruction, perforation, or bleeding, colectomy is a lifesaving treatment and is associated with postoperative mortality up to 48% and morbidity up to 77%. Morbidity and mortality increase with age, comorbidities, and physical frailty. Elderly CRC patients undergoing resection have a greatly increased 1-year mortality risk, as well as worst mid- and long-term survival compared to elective patients of the same age. Chronological age should not be a contraindication for radical surgery, and a curative resection should be performed whenever allowed by disease stage or patient physical status. Palliative treatment may be necessary in up to a third of over 80 patients with complicated cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CC:

Colon cancer

CRC:

Colorectal cancer

ECR:

Emergency colorectal resection

EP:

Emergency presentation

GI:

Gastrointestinal

mFI:

Modified frailty index

MM:

Morbidity and mortality

RC:

Rectal cancer

References

  1. Cao B, Bray F, Beltran-Sanchez H, Ginsburg O, Soneji S, Soerjomataram I. Benchmarking life expectancy and cancer mortality: global comparison with cardiovascular disease 1981–2010. BMJ. 2017;357:j2765.

    Article  Google Scholar 

  2. Neuman HB, O’Connor ES, Weiss J, Loconte NK, Greenblatt DY, Greenberg CC, et al. Surgical treatment of colon cancer in patients aged 80 years and older: analysis of 31,574 patients in the SEER-Medicare database. Cancer. 2013;119(3):639–47.

    Article  Google Scholar 

  3. Soto-Ortiz L, Brody JP. Similarities in the age-specific incidence of colon and testicular cancers. PLoS One. 2013;8(6):e66694.

    Article  CAS  Google Scholar 

  4. Rutten HJ, den Dulk M, Lemmens VE, van de Velde CJ, Marijnen CA. Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol. 2008;9(5):494–501.

    Article  Google Scholar 

  5. Ebell MH, Thai TN, Royalty KJ. Cancer screening recommendations: an international comparison of high income countries. Public Health Rev. 2018;39:7.

    Article  Google Scholar 

  6. Berkowitz Z, Hawkins NA, Peipins LA, White MC, Nadel MR. Beliefs, risk perceptions, and gaps in knowledge as barriers to colorectal cancer screening in older adults. J Am Geriatr Soc. 2008;56(2):307–14.

    Article  Google Scholar 

  7. Renzi C, Lyratzopoulos G, Card T, Chu TP, Macleod U, Rachet B. Do colorectal cancer patients diagnosed as an emergency differ from non-emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage study in England. Br J Cancer. 2016;115(7):866–75.

    Article  CAS  Google Scholar 

  8. Comber H, Sharp L, de Camargo Cancela M, Haase T, Johnson H, Pratschke J. Causes and outcomes of emergency presentation of rectal cancer. Int J Cancer. 2016;139(5):1031–9.

    Article  CAS  Google Scholar 

  9. Govaert JA, Govaert MJ, Fiocco M, van Dijk WA, Tollenaar RA, Wouters MW, et al. Hospital costs of colorectal cancer surgery for the oldest old: a Dutch population-based study. J Surg Oncol. 2016;114(8):1009–15.

    Article  Google Scholar 

  10. Wallace D, Walker K, Kuryba A, Finan P, Scott N, van der Meulen J. Identifying patients at risk of emergency admission for colorectal cancer. Br J Cancer. 2014;111(3):577–80.

    Article  CAS  Google Scholar 

  11. Askari A, Malietzis G, Nachiappan S, Antoniou A, Jenkins J, Kennedy R, et al. Defining characteristics of patients with colorectal cancer requiring emergency surgery. Int J Colorect Dis. 2015;30(10):1329–36.

    Article  Google Scholar 

  12. Rabeneck L, Paszat LF, Li C. Risk factors for obstruction, perforation, or emergency admission at presentation in patients with colorectal cancer: a population-based study. Am J Gastroenterol. 2006;101(5):1098–103.

    Article  Google Scholar 

  13. Geraghty J, Shawihdi M, Devonport E, Sarkar S, Pearson MG, Bodger K. Reduced risk of emergency admission for colorectal cancer associated with the introduction of bowel cancer screening across England: a retrospective national cohort study. Colorectal Dis. 2018;20(2):94–104.

    Article  CAS  Google Scholar 

  14. Aquina CT, Becerra AZ, Xu Z, Boscoe FP, Schymura MJ, Noyes K, et al. Nonelective colon cancer resection: a continued public health concern. Surgery. 2017;161(6):1609–18.

    Article  Google Scholar 

  15. Scott NA, Jeacock J, Kingston RD. Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg. 1995;82(3):321–3.

    Article  CAS  Google Scholar 

  16. Xu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, et al. Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg. 2017;21(3):543–53.

    Article  Google Scholar 

  17. Mothes H, Bauschke A, Schuele S, Eigendorff E, Altendorf-Hofmann A, Settmacher U. Surgery for colorectal cancer in elderly patients: how can we improve outcome? J Cancer Res Clin Oncol. 2017;143(9):1879–89.

    Article  Google Scholar 

  18. Heriot AG, Tekkis PP, Smith JJ, Cohen CR, Montgomery A, Audisio RA, et al. Prediction of postoperative mortality in elderly patients with colorectal cancer. Dis Colon Rectum. 2006;49(6):816–24.

    Article  Google Scholar 

  19. Amri R, Bordeianou LG, Sylla P, Berger DL. Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes. Am J Surg. 2015;209(2):246–53.

    Article  Google Scholar 

  20. Oliphant R, Mansouri D, Nicholson GA, McMillan DC, Horgan PG, Morrison DS, et al. Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival. Int J Colorect Dis. 2014;29(5):591–8.

    Article  Google Scholar 

  21. Ming-Gao G, Jian-Zhong D, Yu W, You-Ben F, Xin-Yu H. Colorectal cancer treatment in octogenarians: elective or emergency surgery? World J Surg Oncol. 2014;12:386.

    Article  Google Scholar 

  22. Goldvaser H, Katz Shroitman N, Ben-Aharon I, Purim O, Kundel Y, Shepshelovich D, et al. Octogenarian patients with colorectal cancer: characterizing an emerging clinical entity. World J Gastroenterol. 2017;23(8):1387–96.

    Article  Google Scholar 

  23. Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol. 2004;13(2–3):149–57.

    Article  Google Scholar 

  24. Baer C, Menon R, Bastawrous S, Bastawrous A. Emergency presentations of colorectal cancer. Surg Clin N Am. 2017;97(3):529–45.

    Article  Google Scholar 

  25. Winner M, Mooney SJ, Hershman DL, Feingold DL, Allendorf JD, Wright JD, et al. Incidence and predictors of bowel obstruction in elderly patients with stage IV colon cancer: a population-based cohort study. JAMA Surg. 2013;148(8):715–22.

    Article  Google Scholar 

  26. Bakker IS, Snijders HS, Grossmann I, Karsten TM, Havenga K, Wiggers T. High mortality rates after nonelective colon cancer resection: results of a national audit. Colorect Dis. 2016;18(6):612–21.

    Article  CAS  Google Scholar 

  27. Tabola R, Mantese G, Cirocchi R, Gemini A, Grassi V, Boselli C, et al. Postoperative mortality and morbidity in older patients undergoing emergency right hemicolectomy for colon cancer. Aging Clin Exp Res. 2017;29(Suppl 1):121–6.

    Article  Google Scholar 

  28. Arezzo A, Passera R, Lo Secco G, Verra M, Bonino MA, Targarona E, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2017;86(3):416–26.

    Article  Google Scholar 

  29. Mizrahi H, Geron N, Parker MC. The outcome of self-expanding metal stents in elderly patients. J Soc Laparoendosc Surg. 2014;18(3):e2014.00038.

    Article  Google Scholar 

  30. Iversen LH, Bulow S, Christensen IJ, Laurberg S, Harling H, Danish Colorectal Cancer Group. Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer. Br J Surg. 2008;95(8):1012–9.

    Article  CAS  Google Scholar 

  31. McGillicuddy EA, Schuster KM, Davis KA, Longo WE. Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg. 2009;144(12):1157–62.

    Article  Google Scholar 

  32. Congiusta DV, Palvannan P, Merchant AM. The impact of frailty on morbidity and mortality following open emergent colectomies. Biomed Res Int. 2017;2017:5126452.

    Article  Google Scholar 

  33. Felli E, Brunetti F, Disabato M, Salloum C, Azoulay D, De’angelis N. Robotic right colectomy for hemorrhagic right colon cancer: a case report and review of the literature of minimally invasive urgent colectomy. World J Emerg Surg. 2014;9:32.

    Article  Google Scholar 

  34. Clere-Jehl R, Schaeffer M, Vogel T, Kiesmann M, Pasquali JL, Andres E, et al. Upper and lower gastrointestinal endoscopies in patients over 85 years of age: risk-benefit evaluation of a longitudinal cohort. Medicine. 2017;96(44):e8439.

    Article  Google Scholar 

  35. Edelman DA, Sugawa C. Lower gastrointestinal bleeding: a review. Surg Endosc. 2007;21(4):514–20.

    Article  Google Scholar 

  36. Vallribera F, Landi F, Espin E, Sanchez JL, Jimenez LM, Marti M, et al. Laparoscopy-assisted versus open colectomy for treatment of colon cancer in the elderly: morbidity and mortality outcomes in 545 patients. Surg Endosc. 2014;28(12):3373–8.

    Article  Google Scholar 

  37. Landi F, Vallribera F, Rivera JP, Bertoli P, Armengol M, Espin E. Morbidity after laparoscopic and open rectal cancer surgery: a comparative analysis of morbidity in octogenarians and younger patients. Colorect Dis. 2016;18(5):459–67.

    Article  CAS  Google Scholar 

  38. Pirrera B, Vaccari S, Cuicchi D, Lecce F, De Raffele E, Via BD, et al. Impact of octogenarians on surgical outcome in colorectal cancer. Int J Surg. 2016;35:28–33.

    Article  Google Scholar 

  39. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203(6):865–77.

    Article  Google Scholar 

  40. McIsaac DI, Moloo H, Bryson GL, van Walraven C. The association of frailty with outcomes and resource use after emergency general surgery: a population-based cohort study. Anesth Analg. 2017;124(5):1653–61.

    Article  Google Scholar 

  41. Obeid NM, Azuh O, Reddy S, Webb S, Reickert C, Velanovich V, et al. Predictors of critical care-related complications in colectomy patients using the National Surgical Quality Improvement Program: exploring frailty and aggressive laparoscopic approaches. J Trauma Acute Care Surg. 2012;72(4):878–83.

    Article  Google Scholar 

  42. Vermillion SA, Hsu FC, Dorrell RD, Shen P, Clark CJ. Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients. J Surg Oncol. 2017;115(8):997–1003.

    Article  Google Scholar 

  43. Buettner S, Wagner D, Kim Y, Margonis GA, Makary MA, Wilson A, et al. Inclusion of sarcopenia outperforms the modified frailty index in predicting 1-year mortality among 1,326 patients undergoing gastrointestinal surgery for a malignant indication. J Am Coll Surg. 2016;222(4):397–407.

    Article  Google Scholar 

  44. Rangel EL, Rios-Diaz AJ, Uyeda JW, Castillo-Angeles M, Cooper Z, Olufajo OA, et al. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery. J Trauma Acute Care Surg. 2017;83(6):1179–86.

    Article  Google Scholar 

  45. Schlichtemeier S, Logaraj A, Gill AJ, Engel A. Colorectal cancer resection in the Australian nonagenarian patient. Colorectal Dis. 2017;19(3):243–50.

    Article  CAS  Google Scholar 

  46. Kolfschoten NE, Wouters MW, Gooiker GA, Eddes EH, Kievit J, Tollenaar RA, et al. Nonelective colon cancer resections in elderly patients: results from the dutch surgical colorectal audit. Digest Surg. 2012;29(5):412–9.

    Article  CAS  Google Scholar 

  47. Modini C, Romagnoli F, De Milito R, Romeo V, Petroni R, La Torre F, et al. Octogenarians: an increasing challenge for acute care and colorectal surgeons. An outcomes analysis of emergency colorectal surgery in the elderly. Colorectal Dis. 2012;14(6):312–8.

    Article  Google Scholar 

  48. De Simone B, Coccolini F, Ansaloni L, Tarasconi A, Baiocchi G, Vettoretto N, et al. Complicated colorectal cancer in nonagenarian patients: is it better not to perform anastomosis in emergency? Turk J Trauma Emerg Surg. 2017;23(1):15–22.

    Google Scholar 

  49. Dekker JW, Gooiker GA, Bastiaannet E, van den Broek CB, van der Geest LG, van de Velde CJ, et al. Cause of death the first year after curative colorectal cancer surgery; a prolonged impact of the surgery in elderly colorectal cancer patients. Eur J Surg Oncol. 2014;40(11):1481–7.

    Article  CAS  Google Scholar 

  50. Dekker JW, van den Broek CB, Bastiaannet E, van de Geest LG, Tollenaar RA, Liefers GJ. Importance of the first postoperative year in the prognosis of elderly colorectal cancer patients. Ann Surg Oncol. 2011;18(6):1533–9.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Colorectal Surgery Unit, General Surgery Service, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona (UAB), Barcelona, Spain

    Filippo Landi & Eloy Espin

Authors
  1. Filippo Landi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eloy Espin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eloy Espin .

Editor information

Editors and Affiliations

  1. Department of General Surgery Unit of Digestive, Minimally Invasive and Robotic Surgery, Henri Mondor Hospital, Créteil, France

    Nicola de'Angelis

  2. Cambridge Colorectal Unit, Cambridge Biomedical Campus, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK

    Salomone Di Saverio

  3. Department of General Surgery Unit of Digestive, Minimally Invasive and Robotic Surgery, Henri Mondor Hospital, Créteil, France

    Francesco Brunetti

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Landi, F., Espin, E. (2019). Medical and Surgical Management of Colorectal Cancer Emergencies in Elderly Patients. In: de'Angelis, N., Di Saverio, S., Brunetti, F. (eds) Emergency Surgical Management of Colorectal Cancer. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-06225-5_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-06225-5_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-06224-8

  • Online ISBN: 978-3-030-06225-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation