Emergency Surgery for Colorectal Cancer in Patients Aged Over 90 Years: Review of the Recent Literature

Abstract

derly people; approximately 60% of patients are aged >70 years at time of diagnosis and 43% of cases are aged >75 years in the western countries [1][2][3] . These proportions will likely continue to increase in the near future, because of the increasing percentage of people living past ninety years, a phenomenon associated with the aging world population.In Italy, according to the Italian National Institute of Statistics (ISTAT) data, the population aged 85 and older will increase from 2.8% in 2011 to 7.8% in 2050, reaching an average life expectancy of 85.3 years for males and 90.5 years for females.This highly significant demographic change in modern society has an important impact on health care, especially in cancer care, as cancer in people aged over 90, poses an ethical dilemma for surgeons and oncologists: non operative management or medical and/or surgical treatment? To treat is an over treatment?In clinical practice, the management of this group of patients is frequently suboptimal, consequently an increasing number of nonagenarian CRC patients are admitted in emergency departments, requiring surgical treatment.Generally, emergency abdominal procedures are associated with increased morbidity and mortality rates, particularly for frail elderly patients. The emergency surgeon often has the crucial role of selecting which patients to submit to surgery, balancing the benefits and the high surgical risk associated with comorbidities.Another important issue to consider is the high costs of the postoperative care for this group of patients which frequently demand rehabilitation and longer recovery, even after minor surgery.We decided to review the recent literature to discuss current strategies in the management of oncogeriatric patients aged over ninety in emergency. MATERIALS AND METHODSWe performed a search by Cochrane Library, MEDLINE, and EMBASE for potentially relevant scientific articles on emergency surgery for colorectal cancer in nonagenarian patients. We considered in our review all the scientific papers published in the last ten years up to June 2015. We included in this study randomized controlled ABSTRACTThe aging of the world population is leading to an increase in the number of patients aged over ninety needing for a surgical treatment in emergency setting. Colorectal cancer in people over 90 years of age represents an ethical dilemma for surgeons and oncologists, above all when the neoplastic disease is advanced and complicated by obstruction and/or perforation. The emergency surgeon often has the crucial role of selecting which patients to submit to surgery, balancing the benefits and the high surgical risk associated with frailty, polipharmacy and comorbidities.We decided to review the recent literature to discuss the latest strate-gies in the management of colorectal cancer in emergency situations, for patients aged over ninety.

Localised perforation of locally advanced transverse colon cancer with spontaneous colocutaneous fistula formation: a clinical challenge

“…However, in this case, we proceeded with emergency laparotomy to manage the oncological emergency. In emergency settings, one-stage surgery (primary resection with anastomosis with or without proximal diversion) is the best choice, when possible, in selected patients; two-stage surgery (resection without anastomosis/Hartmann’s procedure) is indicated in case of peritonitis, in patients haemodynamically unstable and in case of malnourished patients (hypoalbuminaemia), due to high risk of anastomotic leakage 6. For lesions that are in the mid-portion of transverse colon, a transverse colectomy can be performed 2.…”

Sessile Serrated Adenoma of the Appendix and Perforated Cecal Lymphoma in a Nonagenarian on Novel Anticoagulant Undergoing Emergent Surgery: The Challenges, Decision Making and Management of a Rare Case

“…Colorectal neoplasia in patients over 90 years of age represents an ethical dilemma for surgeons, especially when the disease process is advanced and complicated by obstruction and/or perforation. The surgeon often has to weigh the benefits and risks associated with frailty, polypharmacy and comorbidities prior to submitting the patient to surgery [23]. We need to have a clear and precise discussion with the patient and their relatives about treatment options with palliative or curative intent.…”