Optimal oncologic treatment of rectal cancer in patients over 75 years old: Results of a strategy based on oncogeriatric evaluation

Background: Few data are available on the management of elderly rectal cancer patients, and especially on the ability to provide optimal oncological treatment. The aim of this study was to determine the feasibility and results of multimodality treatment for rectal cancer in patients 75 years and older after simplified comprehensive geriatric assessment (CGA) according to Balducci score. Methods: We reviewed the charts of elderly patients who underwent surgery for localized middle or low rectal cancer. Patients were classified into three CGA groups depending on their functional reserve, comorbidities, geriatric syndromes, and life expectancy. Results: Neoadjuvant therapy was discussed for 27 patients (47%), but only 56% of them were treated, including 8, 7, and 1 patient from CGA groups 1, 2, and 3, respectively. Fifty-three patients (93%) underwent sphincter-preserving surgical resection and four patients underwent abdominoperineal resection (7%). Postoperative complications were observed in 21 patients (37%). The postoperative complication rate was correlated non-significantly with age (< 85 years: 40.6%; >= 85 years: 57.1%; P = 0.3), and with the CGA (P = 0.64). In total, 10 patients 18%) had definitive colostomy, including five anastomotic leakages (9%), and one incontinence(2%). The total rate of sphincter preservation was 82% (n = 47). The risk of secondary definitivecolonic stoma formation was not correlated with CGA (group 1: 14%; group 2/3: 16%; P = 0.8). Estimated OS at five years was 52%. Conclusions: After routine geriatric assessment, elderly rectal cancer patients have good rates of sphincter conservation and acceptable morbidity/mortality. (C) 2017 Published by Elsevier Masson SAS.