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3. Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

Author

Fabio Rondelli, Francesco Pata, Francesco Gabrielli, Federica Gaiani, Michael Sugrue, Tiziana Meschi, Simona Bui, Ernest E. Moore, Patricia Tejedor, Antonio Crucitti, Monica Ortenzi, Dario Parini, Ari Leppäniemi, Fabio Cesare Campanile, Mauro Podda, Antonio Biondi, Walter L. Biffl, Salomone Di Saverio, Neil J. Smart, Belinda De Simone, Vanni Agnoletti, Massimo Sartelli, Andrea Polistena, Massimo De Filippo, Gustavo Pereira Fraga, Andrea Loffredo, Adolfo Pisanu, Paolo Carcoforo, Gilberto Poggioli, Gian Luigi de’Angelis, Justin Davies, Gian Luca Baiocchi, Michel Adamina, Marco Vacante, Alessandro Puzziello, Mario Guerrieri, Angelo Guttadauro, Luca Ansaloni, Fausto Catena, Nicola Avenia, Claudia Commisso, Ferdinando Agresta, Giorgio Ercolani, Nicola de’Angelis, Yoram Kluger, Patricia Sylla, Alberto Arezzo, Federico Coccolini, Podda, M, Sylla, P, Baiocchi, G, Adamina, M, Agnoletti, V, Agresta, F, Ansaloni, L, Arezzo, A, Avenia, N, Biffl, W, Biondi, A, Bui, S, Campanile, F, Carcoforo, P, Commisso, C, Crucitti, A, De'Angelis, N, De'Angelis, G, De Filippo, M, De Simone, B, Di Saverio, S, Ercolani, G, Fraga, G, Gabrielli, F, Gaiani, F, Guerrieri, M, Guttadauro, A, Kluger, Y, Leppaniemi, A, Loffredo, A, Meschi, T, Moore, E, Ortenzi, M, Pata, F, Parini, D, Pisanu, A, Poggioli, G, Polistena, A, Puzziello, A, Rondelli, F, Sartelli, M, Smart, N, Sugrue, M, Tejedor, P, Vacante, M, Coccolini, F, Davies, J, Catena, F, Podda M., Sylla P., Baiocchi G., Adamina M., Agnoletti V., Agresta F., Ansaloni L., Arezzo A., Avenia N., Biffl W., Biondi A., Bui S., Campanile F.C., Carcoforo P., Commisso C., Crucitti A., De'Angelis N., De'Angelis G.L., De Filippo M., De Simone B., Di Saverio S., Ercolani G., Fraga G.P., Gabrielli F., Gaiani F., Guerrieri M., Guttadauro A., Kluger Y., Leppaniemi A.K., Loffredo A., Meschi T., Moore E.E., Ortenzi M., Pata F., Parini D., Pisanu A., Poggioli G., Polistena A., Puzziello A., Rondelli F., Sartelli M., Smart N., Sugrue M.E., Tejedor P., Vacante M., Coccolini F., Davies J., and Catena F.

Subjects
medicine.medical_specialty, Consensus, RD1-811, Population, Consensu, Review, 030230 surgery, NO, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Elderly, Multidisciplinary approach, Epidemiology, Multidisciplinary management, medicine, Rectal cancer, humans, education, Research question, LS7_4, Geriatrics, education.field_of_study, Frailty, business.industry, RC86-88.9, elderly, frailty, multidisciplinary management, rectal cancer, aged, disease management, Italy, rectal neoplasms, Medical emergencies. Critical care. Intensive care. First aid, Colorectal surgery, 3. Good health, Geriatric oncology, 030220 oncology & carcinogenesis, Family medicine, Emergency Medicine, Surgery, business, Human
Abstract

Background and aims Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts’ consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods The discussion among the steering group of clinical experts and methodologists from the societies’ expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020–January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.

Published
2021

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