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      Role of surgery for colorectal cancer in the elderly

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          Abstract

          The prevalence of subjects with colorectal cancer is expected to grow in the next future decades and surgery represents the most successful treatment modality for these patients. Anyway, currently elderly subjects undergo less elective surgical procedures than younger patients mainly due to the high rates of postoperative morbidity and mortality. Some authors suggest extensive surgery, including multistage procedures, as carried out in younger patients while others promote less aggressive surgery. In older patients, laparoscopic-assisted colectomy showed a number of advantages compared to conventional open surgery that include lower stress, higher rate of independency after surgery, quicker return to prior activities and a decrease in costs. The recent advances in chemotherapy and the introduction of new surgical procedures such as the endoluminal stenting, suggest the need for a revisitation of surgical practice patterns and the role of palliative surgery, mainly for patients with advanced disease. In this article, we discuss the current role of surgery for elderly patients with colorectal cancer.

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          A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation

          Mary Charlson, Peter Pompei, Kathy Ales … (1987)
          The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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            Global cancer statistics, 2012.

            Lindsey A Torre, Freddie Bray, Rebecca Siegel … (2015)
            Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests. © 2015 American Cancer Society.
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              Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer.

              Thierry André, Corrado Boni, Lamia Mounedji-Boudiaf … (2004)
              The standard adjuvant treatment of colon cancer is fluorouracil plus leucovorin (FL). Oxaliplatin improves the efficacy of this combination in patients with metastatic colorectal cancer. We evaluated the efficacy of treatment with FL plus oxaliplatin in the postoperative adjuvant setting. We randomly assigned 2246 patients who had undergone curative resection for stage II or III colon cancer to receive FL alone or with oxaliplatin for six months. The primary end point was disease-free survival. A total of 1123 patients were randomly assigned to each group. After a median follow-up of 37.9 months, 237 patients in the group given FL plus oxaliplatin had had a cancer-related event, as compared with 293 patients in the FL group (21.1 percent vs. 26.1 percent; hazard ratio for recurrence, 0.77; P=0.002). The rate of disease-free survival at three years was 78.2 percent (95 percent confidence interval, 75.6 to 80.7) in the group given FL plus oxaliplatin and 72.9 percent (95 percent confidence interval, 70.2 to 75.7) in the FL group (P=0.002 by the stratified log-rank test). In the group given FL plus oxaliplatin, the incidence of febrile neutropenia was 1.8 percent, the incidence of gastrointestinal adverse effects was low, and the incidence of grade 3 sensory neuropathy was 12.4 percent during treatment, decreasing to 1.1 percent at one year of follow-up. Six patients in each group died during treatment (death rate, 0.5 percent). Adding oxaliplatin to a regimen of fluorouracil and leucovorin improves the adjuvant treatment of colon cancer. Copyright 2004 Massachusetts Medical Society
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                Author and article information

                Journal
                Journal ID (nlm-ta): World J Gastrointest Surg
                Journal ID (publisher-id): WJGS
                Title: World Journal of Gastrointestinal Surgery
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 1948-9366
                Publication date (Print): 27 September 2016
                Publication date (Electronic): 27 September 2016
                Volume: 8
                Issue: 9
                Pages: 606-613
                Affiliations
                Antonio Biondi, Francesco Basile, Department of Surgery, Vittorio Emanuele Hospital, University of Catania, 95100 Catania, Italy
                Marco Vacante, Erika Cristaldi, Department of Medical and Pediatric Sciences, University of Catania, 95100 Catania, Italy
                Immacolata Ambrosino, Giuseppe Pietrapertosa, Community Hospital Service ULSS 20 Verona, 37122 Verona, Italy
                Author notes

                Author contributions: All authors wrote and critically revised the manuscript.

                Correspondence to: Antonio Biondi, MD, PhD, Associate Professor, Department of Surgery, Vittorio Emanuele Hospital, University of Catania, Via Plebiscito 628, 95100 Catania, Italy. abiondi@ 123456unict.it

                Telephone: +39-95-7435373

                Article
                Other ID: jWJGS.v8.i9.pg606
                DOI: 10.4240/wjgs.v8.i9.606
                PMC ID: 5037333
                PubMed ID: 27721923
                SO-VID: 428aa727-c056-4483-9436-3e208d45246f
                Copyright © ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 25 March 2016
                Date revision received : 15 June 2016
                Date accepted : 14 July 2016
                Categories
                Subject: Minireviews

                Keywords: laparoscopy,colorectal cancer,elderly,comorbidities,colorectal surgery
                Data availability:
                Keywords: laparoscopy, colorectal cancer, elderly, comorbidities, colorectal surgery

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