Surgical and regional treatments for colorectal cancer metastases in older patients: A systematic review and meta-analysis

Abstract

The present study explored the existing literature to describe the outcomes of surgical and regional treatments for colorectal cancer metastases (mCRC) in older patients. Methods A literature search was conducted in PubMed, EMBASE, Cochrane and ClinicalTrials.gov for studies published since 2000 that investigated the short-and long-term outcomes of regional treatments (surgical or non-surgical) for mCRC in patients aged �65 years. Pooled data analyses were conducted by calculating the risk ratio (RR), mean differences (MD) and hazard ratio (HR) between older and younger patients or between two different approaches in older patients. Results After screening 266 articles, 29 were included in this review. These studies reported the outcomes of surgery (n = 19) and non-surgical local ablation treatments (n = 3) for CRC metastases in older vs. younger patients or compared the outcomes of different interventions in

Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050

“…Because the oldest adults are heterogeneous in terms of health status, and fitness, chronologic age alone is often a poor indicator of an individual's physiological or functional status, and should not be used as the sole criterion for treatment decision‐making 16,17 . Cancer survival is lower in this age group compared to other age groups 8‐10,18 ; which is mainly explained by excess mortality in the first months after diagnosis, 9,18 possibly due to suboptimal treatment, higher postoperative mortality, inappropriate risk stratification 16,19,20 . Because some older patients may benefit from surgery or chemotherapy, 21‐23 individualised cancer management (including, but not limited to, modification of treatment schedules and/or dosing and implementation of geriatric‐specific supportive measures) is, therefore, essential in the oldest adults.…”

“…T A B L E 1 Estimated number of new cancer cases in adults aged 80 or older, percentage of total cases (all age combined), percentage of the total population aged 80 years or older and truncated age-standardised incidence rates (TASRs), 2018 [8][9][10]18 ; which is mainly explained by excess mortality in the first months after diagnosis, 9,18 possibly due to suboptimal treatment, higher postoperative mortality, inappropriate risk stratification. 16,19,20 Because some older patients may benefit from surgery or chemotherapy, [21][22][23] individualised cancer management (including, but not limited to, modification of treatment schedules and/or dosing and implementation of geriatric-specific supportive measures) is, therefore, essential in the oldest adults. The utilisation of comprehensive geriatric assessments is crucial to identifying patients that will optimally benefit from treatment, and in countering other deficits that could lead to improved treatment tolerance.…”

Predictors of Survival in Elderly Patients with Metastatic Colon Cancer: A Population-Based Cohort Study

“…Recent studies have shown approximately that 70% to 75% of patients with metastatic colorectal cancer survive beyond one year, 30% to 35% beyond three years, and fewer than 20% beyond five years from diagnosis [ 13 ]. Age is often considered a risk factor for in-hospital morbidity and mortality after colorectal surgery; there is compelling evidence that it is not the actual chronological age of the patient that is a risk for surgery but rather the quality of aging, comorbidity, and the functional status that defines the frailty state [ 14 ]. In our study, age and gender were not correlated with survival.…”

Local Treatments in the Unresectable Patient with Colorectal Cancer Metastasis: A Review from the Point of View of the Medical Oncologist

“…This raises the question of whether elderly patients could benefit from non-surgical treatment of LMCRC. Life expectancy is increasing in Western society, and many patients of LMCRC are diagnosed at an advanced age [ 246 ].…”