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Expert recommendations: personalized management of elderly patients with rectal cancer 31/08/2018

With an expanding elderly population and median rectal cancer detection age of 70 years, the prevalence of rectal cancer in elderly patients is increasing. Management has been based on evidence from younger patients, resulting in substandard treatments and poor outcomes. Modern management of rectal cancer in the elderly demands patient-centered treatment, assessing frailty rather than chronological age. The heterogeneity of this group, combined with the limited available data, impedes drafting evidence-based guidelines. Therefore, a multidisciplinary task force convened experts from the European Society of Surgical Oncology (ESSO), European Society of Coloproctology (ESCP), International Society of Geriatric Oncology (SIOG), and American College of Surgeons Commission on Cancer (ACS CoC), with the goal of identifying the best practice to promote personalized rectal cancer care in older patients.

A crucial element for personalized care was recognized as the routine screening for frailty and geriatrician involvement and personalized care for frail patients. Careful patient selection and improved surgical and perioperative techniques are responsible for a substantial improvement in rectal cancer outcomes. Therefore, properly selected patients should be considered for standard treatments. Local excision can be utilized when balancing oncologic outcomes, frailty and life expectancy. Watch and wait protocols, in expert hands, are valuable for selected patients and adjuncts can be added to improve complete response rates. Functional recovery and patient-reported outcomes are as important as oncologic-specific outcomes in this age group. The recommendations were made based on the best-available evidence to guide the personalized treatment of elderly patients with rectal cancer.

You can read the full article in the European Journal of Surgical Oncology (EJSO) here.

Thank you to the following ESSO members for their contribution and their expertise: Riccardo Audisio, Harm Rutten, Geerard Beets, Giampaolo Ugolini, Roel Hompes and Isacco Montroni.

More about elderly cancer care will be discussed during the 38th Congress of the European Society of Surgical Oncology which will take place from 10-12 October 2018 in Budapest, Hungary. The Educational Session: Geriatric and Emergency Cancer Surgery will cover pre-habilitation, why emergency colorectal cancer surgery has poor results, how it can be improved and a case based presentation: how geriatric assessment maximises the chances of uneventful cancer surgery.


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