Mauro Podda1, Patricia Sylla2, Gianluca Baiocchi3, Michel Adamina4, Vanni Agnoletti5, Ferdinando Agresta6, Luca Ansaloni7, Alberto Arezzo8, Nicola Avenia9, Walter Biffl10, Antonio Biondi11, Simona Bui12, Fabio C Campanile13, Paolo Carcoforo14, Claudia Commisso15, Antonio Crucitti16, Nicola De'Angelis17, Gian Luigi De'Angelis18, Massimo De Filippo15, Belinda De Simone19, Salomone Di Saverio20, Giorgio Ercolani21, Gustavo P Fraga22, Francesco Gabrielli23, Federica Gaiani18, Mario Guerrieri24, Angelo Guttadauro23, Yoram Kluger25, Ari K Leppaniemi26, Andrea Loffredo27, Tiziana Meschi28, Ernest E Moore29, Monica Ortenzi24, Francesco Pata30, Dario Parini31, Adolfo Pisanu32, Gilberto Poggioli33, Andrea Polistena34, Alessandro Puzziello27, Fabio Rondelli9, Massimo Sartelli35, Neil Smart36, Michael E Sugrue37, Patricia Tejedor38, Marco Vacante11, Federico Coccolini39, Justin Davies40, Fausto Catena41. 1. Department of Emergency Surgery, Cagliari University Hospital "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy. mauropodda@ymail.com. 2. Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA. 3. ASST Cremona, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 4. Department of Colorectal Surgery, Cantonal Hospital of Winterthur, Winterthur - University of Basel, Basel, Switzerland. 5. ICU Department, Bufalini Hospital, Cesena, Italy. 6. Department of General Surgery, Vittorio Veneto Hospital, AULSS2 Trevigiana del Veneto, Vittorio Veneto, Italy. 7. 1st General Surgery Unit, University of Pavia, Pavia, Italy. 8. Department of Surgical Sciences, University of Torino, Torino, Italy. 9. SC Chirurgia Generale e Specialità Chirurgiche Azienda Ospedaliera Santa Maria, Università degli Studi di Perugia, Terni, Italy. 10. Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA, USA. 11. Department of General Surgery and Medical - Surgical Specialties, University of Catania, Catania, Italy. 12. Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. 13. Department of Surgery, ASL VT - Ospedale "San Giovanni Decollato - Andosilla", Civita Castellana, Italy. 14. Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy. 15. Department of Radiology, University Hospital of Parma, Parma, Italy. 16. General and Minimally Invasive Surgery Unit, Cristo Re Hospital and Catholic University, Rome, Italy. 17. Unit of Minimally Invasive and Robotic Digestive Surgery, Regional General Hospital F. Miulli, Acquaviva delle Fonti, Bari, Italy. 18. Department of Medicine and Surgery, Gastroenterology and Endoscopy Unit, University of Parma, Parma, Italy. 19. Department of General and Metabolic Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy, France. 20. Department of Surgery, University of Insubria, Varese, Italy. 21. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy. 22. Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil. 23. University of Milano Bicocca, Milano, Italy. 24. Università Politecnica delle Marche, Ancona, Italy. 25. Division of General Surgery, Rambam Health Care Campus, Haifa, Israel. 26. Helsinki University Hospital, University of Helsinki, Helsinki, Finland. 27. UOC Chirurgia Generale - AOU san Giovanni di Dio e Ruggi d'Aragona, Università di Salerno, Salerno, Italy. 28. Department of Medicine and Surgery, University of Parma Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy. 29. Ernest E Moore Shock Trauma Center at Denver Health, Denver, USA. 30. Ospedale Nicola Giannettasio, Corigliano-Rossano, Italy. 31. Santa Maria della Misericordia Hospital, Rovigo, Italy. 32. Department of Emergency Surgery, Cagliari University Hospital "D. Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy. 33. Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy. 34. Dipartimento di Chirurgia Pietro Valdoni Policlinico Umberto I, Sapienza Università degli Studi di Roma, Rome, Italy. 35. Department of Surgery, Macerata Hospital, Macerata, Italy. 36. Exeter Hospital, Exeter, UK. 37. Letterkenny University Hospital and CPM sEUBP Interreg Project, Letterkenny, Ireland. 38. University Hospital 'Gregorio Marañón', Madrid, Spain. 39. General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy. 40. Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK. 41. Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy.
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.
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.
Entities:
Keywords:
Consensus; Elderly; Frailty; Multidisciplinary management; Rectal cancer
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