Updates on the multidisciplinary management of elderly patients with rectal cancer: a narrative review

Introduction: The burden of rectal cancer in the elderly population continues to increase. The aim of this narrative review is to assess evidence updates on the management of elderly patients with rectal cancer. Evidence acquisition: The subject of rectal cancer in patients ≥70 years old was divided into different topics and, based on the research items, the literature review searched relevant studies from MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, and EMBASE between January 2000 and November 2022. Systematic reviews with or without meta-analyses, narrative reviews, randomized trials, and non-randomized cohort studies were included. Evidence synthesis: For the fit elderly patient with preserved sphincter tone, standard-of-care surgical therapy should be pursued, whereas frail patients with more advanced disease could benefit from local excision as a palliative approach in combination with neoadjuvant chemoradiotherapy or more intensive radiotherapy options. Laparoscopic total mesorectal excision is recommended after carefully evaluating the patient's medical history, performance status, and tumor characteristics. Conversely, local excision can be implemented when balancing frailty, oncological outcomes, functional outcomes, and life expectancy. A watch and wait strategy can be considered in selected frail elderly patients with low-rectal tumors in case of complete clinical response after neoadjuvant chemoradiotherapy, with a stringent surveillance protocol, at least in the first three years. Conclusions: In elderly patients with rectal cancer, the adoption of strategies for patient involvement in healthcare decision-making is essential, as well as the evaluation of the social background and a discussion with the patient about therapeutic modalities.