title: Novel approaches to perioperative assessment and intervention may improve long-term outcomes after colorectal cancer resection in older adults.
abstract: Colorectal cancer (CRC) is common among older adults and surgical resection with curative intent is the primary treatment of CRC. Despite the changing demographics of CRC patients and increasing prevalence of multiple comorbidities, surgery is increasingly performed in this complex aging population. Clinically important short-term outcomes have improved for this population, but little is known about long-term outcomes. We review the literature to evaluate trends in CRC surgery in the geriatric population and the outcomes of surgical treatment. We explore the specific gaps in understanding longitudinal patient-centered outcomes of CRC treatment. We then propose adaptations from the geriatrics literature to better predict both short and long-term outcomes after CRC surgery. Interventions, such as prehabilitation, coupled with comprehensive geriatric assessment may be important future strategies for identifying vulnerable older patients, ameliorating the modifiable causes of vulnerability, and improving patient-centered longitudinal outcomes. Further research is needed to determine relevant aspects of geriatric assessments, identify effective intervention strategies, and demonstrate their validity in improving outcomes for at-risk older adults.
authors.affiliation: *Houston Health Services Research and Development Center of Excellence at the Michael E. DeBakey VAMC, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Faisal N
authors.initials: FN
authors.lastname: Cheema
authors.forename: Neena S
authors.initials: NS
authors.lastname: Abraham
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Daniel
authors.initials: D
authors.lastname: Albo
authors.forename: George E
authors.initials: GE
authors.lastname: Taffet
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods* / Q000401:mortality; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome