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

World Journal of Emergency Surgery

Luca Ansaloni¹  Gianluca Baiocchi²  Justin Davies³  Michel Adamina⁴  Adolfo Pisanu⁵  Mauro Podda⁵  Fausto Catena⁶  Antonio Biondi⁷  Marco Vacante⁷  Ferdinando Agresta⁸  Belinda De Simone⁹  Simona Bui^1,10  Gian Luigi De’Angelis^1,11  Federica Gaiani^1,11  Tiziana Meschi^1,12  Massimo De Filippo^1,13  Claudia Commisso^1,13  Fabio C. Campanile^1,14  Massimo Sartelli^1,15  Paolo Carcoforo^1,16  Salomone Di Saverio^1,17  Alberto Arezzo^1,18  Andrea Polistena^1,19  Patricia Sylla^2,20  Yoram Kluger^2,21  Gustavo P. Fraga^2,22  Ernest E. Moore^2,23  Neil Smart^2,24  Antonio Crucitti^2,25  Giorgio Ercolani^2,26  Federico Coccolini^2,27  Ari K. Leppaniemi^2,28  Vanni Agnoletti^2,29  Michael E. Sugrue^3,30  Francesco Pata^3,31  Nicola Avenia^3,32  Fabio Rondelli^3,32  Dario Parini^3,33  Gilberto Poggioli^3,34  Walter Biffl^3,35  Alessandro Puzziello^3,36  Andrea Loffredo^3,36  Nicola De’Angelis^3,37  Patricia Tejedor^3,38  Francesco Gabrielli^3,39  Angelo Guttadauro^3,39  Monica Ortenzi^4,40  Mario Guerrieri^4,40 

[1] 1st General Surgery Unit, University of Pavia, Pavia, Italy;ASST Cremona, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy;Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge, UK;Department of Colorectal Surgery, Cantonal Hospital of Winterthur, Winterthur - University of Basel, Basel, Switzerland;Department of Emergency Surgery, Cagliari University Hospital “D. Casula”, Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy;Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy;Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy;Department of General Surgery, Vittorio Veneto Hospital, AULSS2 Trevigiana del Veneto, Vittorio Veneto, Italy;Department of General and Metabolic Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France;Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy;Department of Medicine and Surgery, Gastroenterology and Endoscopy Unit, University of Parma, Parma, Italy;Department of Medicine and Surgery, University of Parma Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy;Department of Radiology, University Hospital of Parma, Parma, Italy;Department of Surgery, ASL VT - Ospedale “San Giovanni Decollato - Andosilla”, Civita Castellana, Italy;Department of Surgery, Macerata Hospital, Macerata, Italy;Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy;Department of Surgery, University of Insubria, Varese, Italy;Department of Surgical Sciences, University of Torino, Torino, Italy;Dipartimento di Chirurgia Pietro Valdoni Policlinico Umberto I, Sapienza Università degli Studi di Roma, Rome, Italy;Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA;Division of General Surgery, Rambam Health Care Campus, Haifa, Israel;Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil;Ernest E Moore Shock Trauma Center at Denver Health, Denver, USA;Exeter Hospital, Exeter, UK;General and Minimally Invasive Surgery Unit, Cristo Re Hospital and Catholic University, Rome, Italy;General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy;General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy;Helsinki University Hospital, University of Helsinki, Helsinki, Finland;ICU Department, Bufalini Hospital, Cesena, Italy;Letterkenny University Hospital and CPM sEUBP Interreg Project, Letterkenny, Ireland;Ospedale Nicola Giannettasio, Corigliano-Rossano, Italy;SC Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy;Santa Maria della Misericordia Hospital, Rovigo, Italy;Surgery of the Alimentary Tract, Sant’Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy;Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA;UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d’Aragona, Università di Salerno, Salerno, Italy;Unit of Minimally Invasive and Robotic Digestive Surgery, Regional General Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy;University Hospital ‘Gregorio Marañón’, Madrid, Spain;University of Milano Bicocca, Milano, Italy;Università Politecnica delle Marche, Ancona, Italy;

关键词: Rectal cancer;    Elderly;    Frailty;    Multidisciplinary management;    Consensus;   

DOI  :  10.1186/s13017-021-00378-9

来源: Springer

【 摘 要 】

Background and aimsAlthough 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.MethodsThe 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.ConclusionsThe 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.

【 授权许可】

CC BY