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Rectal Cancer Treatment in the Elderly

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Modern Management of Cancer of the Rectum

Abstract

Elderly rectal cancer patients are a heterogeneous group of patients ranging from the very fit to the frail patients who are at high risk of treatment complications. Most elderly have comorbidities which adversely affects outcome. In addition treatment related complications have more impact on outcome in elderly patients. Therefore a different approach compared to younger patients is needed. Only after a meticulous assessment of the physiological status and adequate counselling of the patient an individual treatment plan can be determined. Shared decision making is essential in the treatment of rectal cancer in the elderly.

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References

  1. Balducci L. Geriatric oncology: challenges for the new century. Eur J Cancer. 2000;36(14):1741–54.

    CAS  PubMed  Google Scholar 

  2. Martin FC, Brighton P. Frailty: different tools for different purposes? Age Ageing. 2008;37(2):129–31.

    PubMed  Google Scholar 

  3. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12(1):29–37.

    CAS  PubMed  Google Scholar 

  4. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    CAS  PubMed  Google Scholar 

  5. Kristjansson SR, Nesbakken A, Jordhoy MS, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010;76(3):208–17.

    PubMed  Google Scholar 

  6. Clgg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    Google Scholar 

  7. Extermann M, Aapro M. Assessment of the older cancer patient. Hematol Oncol Clin North Am. 2000;14(1):63–77, vii–ix.

    CAS  PubMed  Google Scholar 

  8. Repetto L, Comandini D. Cancer in the elderly: assessing patients for fitness. Crit Rev Oncol Hematol. 2000;35(3):155–60.

    CAS  PubMed  Google Scholar 

  9. Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol. 2002;20(2):494–502.

    PubMed  Google Scholar 

  10. Kristjansson SR, Jordhoy MS, Nesbakken A, et al. Which elements of a comprehensive geriatric assessment (CGA) predict post-operative complications and early mortality after colorectal cancer surgery? J Geriatr Oncol. 2010;1(2):57–65.

    Google Scholar 

  11. Repetto L, Venturino A, Fratino L, et al. Geriatric oncology: a clinical approach to the older patient with cancer. Eur J Cancer. 2003;39(7):870–80.

    CAS  PubMed  Google Scholar 

  12. Gosney MA. Clinical assessment of elderly people with cancer. Lancet Oncol. 2005;6(10):790–7.

    PubMed  Google Scholar 

  13. Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol. 1998;16(4):1582–7.

    CAS  PubMed  Google Scholar 

  14. Hurria A, Gupta S, Zauderer M, et al. Developing a cancer-specific geriatric assessment: a feasibility study. Cancer. 2005;104(9):1998–2005.

    PubMed  Google Scholar 

  15. Audisio RA, Pope D, Ramesh HS, et al. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65(2):156–63.

    PubMed  Google Scholar 

  16. Brouquet A, Cudennec T, Benoist S, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg. 2010;251(4):759–65.

    PubMed  Google Scholar 

  17. Huisman MG, van Leeuwen BL, Ugolini G, et al. “Timed Up & Go”: a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study. PLoS One. 2014;9(1):e86863.

    PubMed Central  PubMed  Google Scholar 

  18. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.

    CAS  PubMed  Google Scholar 

  19. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78(3):355–60.

    CAS  PubMed  Google Scholar 

  20. Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland Jr JC, Moss M. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013;206(4):544–50.

    PubMed Central  PubMed  Google Scholar 

  21. Chen RC, Royce TJ, Extermann M, Reeve BB. Impact of age and comorbidity on treatment and outcomes in elderly cancer patients. Semin Radiat Oncol. 2012;22(4):265–71.

    PubMed  Google Scholar 

  22. van Leeuwen BL, Huisman MG, Audisio RA. Surgery in older cancer patients - recent results and new techniques: worth the investment? Interdiscip Top Gerontol. 2013;38:124–31.

    PubMed  Google Scholar 

  23. Liu JJ, Extermann M. Comprehensive geriatric assessment and its clinical impact in oncology. Clin Geriatr Med. 2012;28(1):19–31.

    PubMed  Google Scholar 

  24. Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750–6.

    CAS  PubMed  Google Scholar 

  25. Dharma-Wardene MW, de Gara C, Au HJ, Hanson J, Hatcher J. Ageism in rectal carcinoma? Treatment and outcome variations. Int J Gastrointest Cancer. 2002;32(2–3):129–38.

    PubMed  Google Scholar 

  26. Chang GJ, Skibber JM, Feig BW, Rodriguez-Bigas M. Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg. 2007;246(2):215–21.

    PubMed Central  PubMed  Google Scholar 

  27. Van Leersum NJ, Janssen-Heijnen ML, Wouters MW, et al. Increasing prevalence of comorbidity in patients with colorectal cancer in the South of the Netherlands 1995–2010. Int J Cancer. 2013;132(9):2157–63.

    PubMed  Google Scholar 

  28. Dekker JW, Gooiker GA, van der Geest LG, et al. Use of different comorbidity scores for risk-adjustment in the evaluation of quality of colorectal cancer surgery: does it matter? Eur J Surg Oncol. 2012;38(11):1071–8.

    CAS  PubMed  Google Scholar 

  29. Janssen-Heijnen ML, Maas HA, Houterman S, Lemmens VE, Rutten HJ, Coebergh JW. Comorbidity in older surgical cancer patients: influence on patient care and outcome. Eur J Cancer. 2007;43(15):2179–93.

    PubMed  Google Scholar 

  30. Faivre J, Lemmens VE, Quipourt V, Bouvier AM. Management and survival of colorectal cancer in the elderly in population-based studies. Eur J Cancer. 2007;43(15):2279–84.

    CAS  PubMed  Google Scholar 

  31. Nedrebo BS, Soreide K, Eriksen MT, et al. Survival effect of implementing national treatment strategies for curatively resected colonic and rectal cancer. Br J Surg. 2011;98(5):716–23.

    CAS  PubMed  Google Scholar 

  32. Papamichael D, Audisio R, Horiot JC, et al. Treatment of the elderly colorectal cancer patient: SIOG expert recommendations. Ann Oncol. 2009;20(1):5–16.

    CAS  PubMed  Google Scholar 

  33. Tudyka V, Blomqvist L, Beets-Tan RG, et al. EURECCA consensus conference highlights about colon & rectal cancer multidisciplinary management: the radiology experts review. Eur J Surg Oncol. 2013;40(4):469–75.

    PubMed  Google Scholar 

  34. MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology. 2007;243(1):132–9.

    Google Scholar 

  35. Taylor FG, Quirke P, Heald RJ, et al. One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. Br J Surg. 2011;98(6):872–9.

    CAS  PubMed  Google Scholar 

  36. Kristjansson SR, Farinella E, Gaskell S, Audisio RA. Surgical risk and post-operative complications in older unfit cancer patients. Cancer Treat Rev. 2009;35(6):499–502.

    PubMed  Google Scholar 

  37. Extermann M. Integrating a geriatric evaluation in the clinical setting. Semin Radiat Oncol. 2012;22(4):272–6.

    PubMed  Google Scholar 

  38. Palmer G, Martling A, Cedermark B, Holm T. Preoperative tumour staging with multidisciplinary team assessment improves the outcome in locally advanced primary rectal cancer. Colorectal Dis. 2011;13(12):1361–9.

    CAS  PubMed  Google Scholar 

  39. MacDermid E, Hooton G, MacDonald M, et al. Improving patient survival with the colorectal cancer multi-disciplinary team. Colorectal Dis. 2009;11(3):291–5.

    CAS  PubMed  Google Scholar 

  40. Augestad KM, Lindsetmo RO, Stulberg J, et al. International preoperative rectal cancer management: staging, neoadjuvant treatment, and impact of multidisciplinary teams. World J Surg. 2010;34(11):2689–700.

    PubMed Central  PubMed  Google Scholar 

  41. Segelman J, Singnomklao T, Hellborg H, Martling A. Differences in multidisciplinary team assessment and treatment between patients with stage IV colon and rectal cancer. Colorectal Dis. 2009;11(7):768–74.

    CAS  PubMed  Google Scholar 

  42. Kohne CH, Folprecht G, Goldberg RM, Mitry E, Rougier P. Chemotherapy in elderly patients with colorectal cancer. Oncologist. 2008;13(4):390–402.

    PubMed  Google Scholar 

  43. Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol. 2004;22(22):4626–31.

    PubMed  Google Scholar 

  44. Ayanian JZ, Zaslavsky AM, Fuchs CS, et al. Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. J Clin Oncol. 2003;21(7):1293–300.

    PubMed  Google Scholar 

  45. Schrag D, Gelfand SE, Bach PB, Guillem J, Minsky BD, Begg CB. Who gets adjuvant treatment for stage II and III rectal cancer? Insight from surveillance, epidemiology, and end results–Medicare. J Clin Oncol. 2001;19(17):3712–8.

    CAS  PubMed  Google Scholar 

  46. Potosky AL, Harlan LC, Kaplan RS, Johnson KA, Lynch CF. Age, sex, and racial differences in the use of standard adjuvant therapy for colorectal cancer. J Clin Oncol. 2002;20(5):1192–202.

    PubMed  Google Scholar 

  47. Lemmens VE, Janssen-Heijnen ML, Verheij CD, Houterman S, Repelaer van Driel OJ, Coebergh JW. Co-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer. Br J Surg. 2005;92(5):615–23.

    CAS  PubMed  Google Scholar 

  48. Goodwin JS, Hunt WC, Samet JM. Determinants of cancer therapy in elderly patients. Cancer. 1993;72(2):594–601.

    CAS  PubMed  Google Scholar 

  49. Newcomb PA, Carbone PP. Cancer treatment and age: patient perspectives. J Natl Cancer Inst. 1993;85(19):1580–4.

    CAS  PubMed  Google Scholar 

  50. Coburn MC, Pricolo VE, Soderberg CH. Factors affecting prognosis and management of carcinoma of the colon and rectum in patients more than eighty years of age. J Am Coll Surg. 1994;179(1):65–9.

    CAS  PubMed  Google Scholar 

  51. Cohen SM, Neugut AI. Adjuvant therapy for rectal cancer in the elderly. Drugs Aging. 2004;21(7):437–51.

    PubMed  Google Scholar 

  52. Pallis AG, Papamichael D, Audisio R, et al. EORTC Elderly Task Force experts’ opinion for the treatment of colon cancer in older patients. Cancer Treat Rev. 2010;36(1):83–90.

    CAS  PubMed  Google Scholar 

  53. Rutten H, den Dulk M, Lemmens V, et al. Survival of elderly rectal cancer patients not improved: analysis of population based data on the impact of TME surgery. Eur J Cancer. 2007;43(15):2295–300.

    PubMed  Google Scholar 

  54. Maas HA, Lemmens VE, Nijhuis PH, de Hingh I, Koning CC, Janssen-Heijnen ML. Benefits and drawbacks of short-course preoperative radiotherapy in rectal cancer patients aged 75 years and older. Eur J Surg Oncol. 2013;39(10):1087–93.

    CAS  PubMed  Google Scholar 

  55. Martijn H, Vulto JC. Should radiotherapy be avoided or delivered differently in elderly patients with rectal cancer? Eur J Cancer. 2007;43(15):2301–6.

    CAS  PubMed  Google Scholar 

  56. Pignon T, Horiot JC, Bolla M, et al. Age is not a limiting factor for radical radiotherapy in pelvic malignancies. Radiother Oncol. 1997;42(2):107–20.

    CAS  PubMed  Google Scholar 

  57. Margalit DN, Mamon HJ, Ancukiewicz M, et al. Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Int J Radiat Oncol Biol Phys. 2011;81(5):e735–41.

    PubMed  Google Scholar 

  58. Gerard JP, Azria D, Gourgou-Bourgade S, et al. Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol. 2010;28(10):1638–44.

    CAS  PubMed  Google Scholar 

  59. Francois E, Azria D, Gourgou-Bourgade S, et al. Results in the elderly with locally advanced rectal cancer from the ACCOR12/PRODIGE 2 phase III trial: tolerance and efficacy. Radiother Oncol. 2014;110(1):144–9.

    PubMed  Google Scholar 

  60. Pettersson D, Holm T, Iversen H, Blomqvist L, Glimelius B, Martling A. Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer. Br J Surg. 2012;99(4):577–83.

    CAS  PubMed  Google Scholar 

  61. Pettersson D, Cedermark B, Holm T, et al. Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg. 2010;97(4):580–7.

    CAS  PubMed  Google Scholar 

  62. Feliu J, Sereno M, Castro JD, Belda C, Casado E, Gonzalez-Baron M. Chemotherapy for colorectal cancer in the elderly: whom to treat and what to use. Cancer Treat Rev. 2009;35(3):246–54.

    PubMed  Google Scholar 

  63. Lichtman SM. Management of advanced colorectal cancer in older patients. Oncology (Williston Park). 2005;19(5):597–602.

    Google Scholar 

  64. Meulenbeld HJ, Creemers GJ. First-line treatment strategies for elderly patients with metastatic colorectal cancer. Drugs Aging. 2007;24(3):223–38.

    CAS  PubMed  Google Scholar 

  65. Seymour MT, Thompson LC, Wasan HS, et al. Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial. Lancet. 2011;377(9779):1749–59.

    CAS  PubMed Central  PubMed  Google Scholar 

  66. Berger DH, Roslyn JJ. Cancer surgery in the elderly. Clin Geriatr Med. 1997;13(1):119–41.

    CAS  PubMed  Google Scholar 

  67. Kemeny MM, Busch-Devereaux E, Merriam LT, O'Hea BJ. Cancer surgery in the elderly. Hematol Oncol Clin North Am. 2000;14(1):169–92.

    CAS  PubMed  Google Scholar 

  68. Mamidanna R, Eid-Arimoku L, Almoudaris AM, et al. Poor 1-year survival in elderly patients undergoing nonelective colorectal resection. Dis Colon Rectum. 2012;55(7):788–96.

    PubMed  Google Scholar 

  69. Kolfschoten NE, Wouters MW, Gooiker GA, et al. Nonelective colon cancer resections in elderly patients: results from the Dutch surgical colorectal audit. Dig Surg. 2012;29(5):412–9.

    CAS  PubMed  Google Scholar 

  70. Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group. Lancet. 2000;356(9234):968–74.

    Google Scholar 

  71. Devon KM, Vergara-Fernandez O, Victor JC, McLeod RS. Colorectal cancer surgery in elderly patients: presentation, treatment, and outcomes. Dis Colon Rectum. 2009;52(7):1272–7.

    CAS  PubMed  Google Scholar 

  72. Schwandner O, Schiedeck TH, Bruch HP. Advanced age–indication or contraindication for laparoscopic colorectal surgery? Dis Colon Rectum. 1999;42(3):356–62.

    CAS  PubMed  Google Scholar 

  73. Frasson M, Braga M, Vignali A, Zuliani W, Di Carlo V. Benefits of laparoscopic colorectal resection are more pronounced in elderly patients. Dis Colon Rectum. 2008;51(3):296–300.

    PubMed  Google Scholar 

  74. Feng B, Zheng MH, Mao ZH, et al. Clinical advantages of laparoscopic colorectal cancer surgery in the elderly. Aging Clin Exp Res. 2006;18(3):191–5.

    PubMed  Google Scholar 

  75. Law WL, Chu KW, Tung PH. Laparoscopic colorectal resection: a safe option for elderly patients. J Am Coll Surg. 2002;195(6):768–73.

    PubMed  Google Scholar 

  76. Vignali A, Di PS, Tamburini A, Radaelli G, Orsenigo E, Staudacher C. Laparoscopic vs. open colectomies in octogenarians: a case-matched control study. Dis Colon Rectum. 2005;48(11):2070–5.

    PubMed  Google Scholar 

  77. 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.

    CAS  PubMed Central  PubMed  Google Scholar 

  78. Visser BC, Keegan H, Martin M, Wren SM. Death after colectomy: it’s later than we think. Arch Surg. 2009;144(11):1021–7.

    PubMed  Google Scholar 

  79. Gooiker GA, Dekker JW, Bastiaannet E, et al. Risk factors for excess mortality in the first year after curative surgery for colorectal cancer. Ann Surg Oncol. 2012;19(8):2428–34.

    PubMed Central  PubMed  Google Scholar 

  80. 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.

    PubMed  Google Scholar 

  81. Iversen LH, Pedersen L, Riis A, Friis S, Laurberg S, Sorensen HT. Age and colorectal cancer with focus on the elderly: trends in relative survival and initial treatment from a Danish population-based study. Dis Colon Rectum. 2005;48(9):1755–63.

    PubMed  Google Scholar 

  82. Mitry E, Bouvier AM, Esteve J, Faivre J. Benefit of operative mortality reduction on colorectal cancer survival. Br J Surg. 2002;89(12):1557–62.

    CAS  PubMed  Google Scholar 

  83. Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T. Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg. 2014;101(4):424–32.

    CAS  PubMed  Google Scholar 

  84. den Dulk M, Smit M, Peeters KC, et al. A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol. 2007;8(4):297–303.

    Google Scholar 

  85. Orsini RG, Thong MS, van de Poll-Franse LV, et al. Quality of life of older rectal cancer patients is not impaired by a permanent stoma. Eur J Surg Oncol. 2013;39(2):164–70.

    CAS  PubMed  Google Scholar 

  86. Cornish JA, Tilney HS, Heriot AG, Lavery IC, Fazio VW, Tekkis PP. A meta-analysis of quality of life for abdominoperineal excision of rectum versus anterior resection for rectal cancer. Ann Surg Oncol. 2007;14(7):2056–68.

    PubMed  Google Scholar 

  87. Pachler J, Wille-Jorgensen P. Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev. 2012;12:CD004323.

    Google Scholar 

  88. Bregendahl S, Emmertsen KJ, Lous J, Laurberg S. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis. 2013;15(9):1130–9.

    CAS  PubMed  Google Scholar 

  89. Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922–8.

    PubMed  Google Scholar 

  90. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109–17.

    CAS  PubMed  Google Scholar 

  91. El-Sharkawy AM, Sahota O, Maughan RJ, Lobo DN. The pathophysiology of fluid and electrolyte balance in the older adult surgical patient. Clin Nutr. 2014;33(1):6–13.

    CAS  PubMed  Google Scholar 

  92. Arieff AI. Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest. 1999;115(5):1371–7.

    CAS  PubMed  Google Scholar 

  93. Lobo DN, Macafee DA, Allison SP. How perioperative fluid balance influences postoperative outcomes. Best Pract Res Clin Anaesthesiol. 2006;20(3):439–55.

    PubMed  Google Scholar 

  94. Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth. 2002;89(4):622–32.

    CAS  PubMed  Google Scholar 

  95. Payen D, de Pont AC, Sakr Y, Spies C, Reinhart K, Vincent JL. A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care. 2008;12(3):R74.

    PubMed Central  PubMed  Google Scholar 

  96. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359(9320):1812–8.

    PubMed  Google Scholar 

  97. Khan AA, Wheeler JM, Cunningham C, George B, Kettlewell M, Mortensen NJ. The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis. 2008;10(6):587–92.

    CAS  PubMed  Google Scholar 

  98. Winde G, Nottberg H, Keller R, Schmid KW, Bunte H. Surgical cure for early rectal carcinomas (T1). Transanal endoscopic microsurgery vs. anterior resection. Dis Colon Rectum. 1996;39(9):969–76.

    CAS  PubMed  Google Scholar 

  99. Dafnis G, Pahlman L, Raab Y, Gustafsson UM, Graf W. Transanal endoscopic microsurgery: clinical and functional results. Colorectal Dis. 2004;6(5):336–42.

    CAS  PubMed  Google Scholar 

  100. Endreseth BH, Wibe A, Svinsas M, Marvik R, Myrvold HE. Postoperative morbidity and recurrence after local excision of rectal adenomas and rectal cancer by transanal endoscopic microsurgery. Colorectal Dis. 2005;7(2):133–7.

    CAS  PubMed  Google Scholar 

  101. Lee W, Lee D, Choi S, Chun H. Transanal endoscopic microsurgery and radical surgery for T1 and T2 rectal cancer. Surg Endosc. 2003;17(8):1283–7.

    CAS  PubMed  Google Scholar 

  102. Paty PB, Nash GM, Baron P, et al. Long-term results of local excision for rectal cancer. Ann Surg. 2002;236(4):522–9.

    PubMed Central  PubMed  Google Scholar 

  103. Mellgren A, Sirivongs P, Rothenberger DA, Madoff RD, Garcia-Aguilar J. Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum. 2000;43(8):1064–71.

    CAS  PubMed  Google Scholar 

  104. Lezoche G, Baldarelli M, Guerrieri M, et al. A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc. 2008;22(2):352–8.

    CAS  PubMed  Google Scholar 

  105. Borschitz T, Wachtlin D, Mohler M, Schmidberger H, Junginger T. Neoadjuvant chemoradiation and local excision for T2-3 rectal cancer. Ann Surg Oncol. 2008;15(3):712–20.

    PubMed  Google Scholar 

  106. Lezoche E, Guerrieri M, Paganini AM, Feliciotti F. Long-term results of patients with pT2 rectal cancer treated with radiotherapy and transanal endoscopic microsurgical excision. World J Surg. 2002;26(9):1170–4.

    PubMed  Google Scholar 

  107. Habr-Gama A, Perez RO, Nadalin W, et al. Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival. J Gastrointest Surg. 2005;9(1):90–9.

    PubMed  Google Scholar 

  108. Habr-Gama A, Perez RO, Sao Juliao GP, Proscurshim I, Gama-Rodrigues J. Nonoperative approaches to rectal cancer: a critical evaluation. Semin Radiat Oncol. 2011;21(3):234–9.

    PubMed  Google Scholar 

  109. Habr-Gama A, Gama-Rodrigues J, Sao Juliao GP, et al. Local recurrence after complete clinical response and watch and wait in rectal cancer after neoadjuvant chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys. 2014;88(4):822–8.

    PubMed  Google Scholar 

  110. Maas M, Beets-Tan RG, Lambregts DM, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011;29(35):4633–40.

    PubMed  Google Scholar 

  111. Glynne-Jones R, Hughes R. Critical appraisal of the ‘wait and see’ approach in rectal cancer for clinical complete responders after chemoradiation. Br J Surg. 2012;99(7):897–909.

    CAS  PubMed  Google Scholar 

  112. O’Neill BD, Brown G, Heald RJ, Cunningham D, Tait DM. Non-operative treatment after neoadjuvant chemoradiotherapy for rectal cancer. Lancet Oncol. 2007;8(7):625–33.

    PubMed  Google Scholar 

  113. Papillon J. Present status of radiation therapy in the conservative management of rectal cancer. Radiother Oncol. 1990;17(4):275–83.

    CAS  PubMed  Google Scholar 

  114. Gerard JP, Chapet O, Ortholan C, Benezery K, Barbet N, Romestaing P. French experience with contact X-ray endocavitary radiation for early rectal cancer. Clin Oncol (R Coll Radiol). 2007;19(9):661–73.

    CAS  Google Scholar 

  115. Sun MA, Grieve RJ, McDonald AC, et al. Combined modality treatment of early rectal cancer: the UK experience. Clin Oncol (R Coll Radiol). 2007;19(9):674–81.

    Google Scholar 

  116. Sun MA, Lee CD, Snee AJ, Perkins K, Jelley FE, Wong H. High dose rate brachytherapy as a boost after preoperative chemoradiotherapy for more advanced rectal tumours: the Clatterbridge experience. Clin Oncol (R Coll Radiol). 2007;19(9):711–9.

    Google Scholar 

  117. Gerard JP, Romestaing P, Chapet O. Radiotherapy alone in the curative treatment of rectal carcinoma. Lancet Oncol. 2003;4(3):158–66.

    PubMed  Google Scholar 

  118. Cirocchi R, Farinella E, Trastulli S, et al. Safety and efficacy of endoscopic colonic stenting as a bridge to surgery in the management of intestinal obstruction due to left colon and rectal cancer: a systematic review and meta-analysis. Surg Oncol. 2013;22(1):14–21.

    PubMed  Google Scholar 

  119. Suarez J, Jimenez J, Vera R, et al. Stent or surgery for incurable obstructive colorectal cancer: an individualized decision. Int J Colorectal Dis. 2010;25(1):91–6.

    PubMed  Google Scholar 

  120. Baron TH. Indications and results of endoscopic rectal stenting. J Gastrointest Surg. 2004;8(3):266–9.

    PubMed  Google Scholar 

  121. Hunerbein M, Krause M, Moesta KT, Rau B, Schlag PM. Palliation of malignant rectal obstruction with self-expanding metal stents. Surgery. 2005;137(1):42–7.

    PubMed  Google Scholar 

  122. Ronnekleiv-Kelly SM, Kennedy GD. Management of stage IV rectal cancer: palliative options. World J Gastroenterol. 2011;17(7):835–47.

    PubMed Central  PubMed  Google Scholar 

  123. Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Self-expanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246(1):24–30.

    PubMed Central  PubMed  Google Scholar 

  124. van de Velde CJ, Aristei C, Boelens PG, et al. EURECCA colorectal: multidisciplinary mission statement on better care for patients with colon and rectal cancer in Europe. Eur J Cancer. 2013;49(13):2784–90.

    PubMed  Google Scholar 

  125. Breitenstein S, Rickenbacher A, Berdajs D, Puhan M, Clavien PA, Demartines N. Systematic evaluation of surgical strategies for acute malignant left-sided colonic obstruction. Br J Surg. 2007;94(12):1451–60.

    CAS  PubMed  Google Scholar 

  126. van Hooft JE, Bemelman WA, Oldenburg B, et al. Colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction: a multicentre randomised trial. Lancet Oncol. 2011;12(4):344–52.

    PubMed  Google Scholar 

  127. Mastracci TM, Hendren S, O’Connor B, McLeod RS. The impact of surgery for colorectal cancer on quality of life and functional status in the elderly. Dis Colon Rectum. 2006;49(12):1878–84.

    PubMed  Google Scholar 

  128. Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B. Impact of age on quality of life in patients with rectal cancer. World J Surg. 2005;29(2):190–7.

    PubMed  Google Scholar 

  129. Vermeer TA, Orsini RG, Rutten HJ. Surgery for rectal cancer-what is on the horizon? Curr Oncol Rep. 2014;16(3):372.

    PubMed  Google Scholar 

  130. McArdle CS, Hole DJ. Influence of volume and specialization on survival following surgery for colorectal cancer. Br J Surg. 2004;91(5):610–7.

    CAS  PubMed  Google Scholar 

  131. Borowski DW, Kelly SB, Bradburn DM, Wilson RG, Gunn A, Ratcliffe AA. Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery. Br J Surg. 2007;94(7):880–9.

    CAS  PubMed  Google Scholar 

  132. Van Leersum NJ, Snijders HS, Henneman D, et al. The Dutch surgical colorectal audit. Eur J Surg Oncol. 2013;39(10):1063–70.

    PubMed  Google Scholar 

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Acknowledgments

Lieke Gieteling analysed the DSCA database en provided Fig. 25.3.

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Authors and Affiliations

  1. Department of Surgery, Catharina Hospital, Eindhoven, 5623 EJ, The Netherlands

    Ricardo G. Orsini MD

  2. Department of Geriatric Medicine, Oslo University Hospital, Oslo, 0424, Norway

    Siri Rostoft MD, PhD

  3. Department of Colorectal Surgery, Catharina Hospital Eindhoven, Eindhoven, 5623 EJ, The Netherlands

    Harm J. T. Rutten MD, PhD, FRCS(London)

Authors
  1. Ricardo G. Orsini MD
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  2. Siri Rostoft MD, PhD
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  3. Harm J. T. Rutten MD, PhD, FRCS(London)
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Correspondence to Harm J. T. Rutten MD, PhD, FRCS(London) .

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Editors and Affiliations

  1. Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Walter E. Longo

  2. Colon and Rectal Surgery, Yale School of Medicine, New Haven, Connecticut, USA

    Vikram Reddy

  3. University of Liverpool St Helens Teaching Hospital, St Helens, United Kingdom

    Riccardo A. Audisio

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Orsini, R.G., Rostoft, S., Rutten, H.J.T. (2015). Rectal Cancer Treatment in the Elderly. In: Longo, W., Reddy, V., Audisio, R. (eds) Modern Management of Cancer of the Rectum. Springer, London. https://doi.org/10.1007/978-1-4471-6609-2_25

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