Treatment of rectal cancer in the older population

Abstract

The majority of rectal cancer patients are elderly. Biological age, not chronological age alone, is the main risk factor of postoperative morbidity in this group. Therefore, based on the Comprehensive Geriatric Assessment, we can differentiate three groups of patients: fit, pre-frail and frail. In the fit group, a standard multimodal oncologic treatment can be offered. In the pre-frail group, prerehabilitation should be recommended to improved resilience to surgical stress. In frail patients, a tailored approach should be discussed in a geriatric multidisciplinary team meeting. At present, a whole range of multimodal tailored approaches can be offered to rectal cancer patients. In this group, of much more importance is postoperative functional recovery, including both organ-specific outcomes and the ability to regain independence than currently used outcome indicators. Therefore, as important as cancer staging and tumour biology, it is crucial to understand the health status of an older patient with rectal cancer.