Document Detail

Controversies of total mesorectal excision for rectal cancer in elderly patients.
MedLine Citation:
PMID:  18452860     Owner:  NLM     Status:  MEDLINE    
The cornerstone of treatment for rectal cancer is resectional treatment according to the principles of total mesorectal excision (TME). However, population-based registries show that improvements in outcome after resectional treatment occur mainly in younger patients. Furthermore, 6-month postoperative mortality is significantly increased in elderly patients (> or = 75 years of age) compared with younger patients (< 75 years of age). Several confounding factors, such as treatment-related complications and comorbidity, are thought to be responsible for these disappointing findings. Thus, major resectional treatment is not advantageous for all older patients with rectal cancer. However, the Dutch TME trial showed a good response to a short course of neoadjuvant radiotherapy in elderly patients. Biological responses to cancer treatment seem to change with age, and, therefore, individualised cancer treatments should be used that take into account the heterogeneity of ageing. For elderly patients who retain a good physical and mental condition, treatment that is given to younger patients is deemed appropriate, whereas for those with diminished physiological reserves and comorbid conditions, alternative treatments that keep surgical trauma to a minimum and optimise the use of radiotherapy might be more suitable.
Harm J T Rutten; Marcel den Dulk; Valery E P P Lemmens; Cornelis J H van de Velde; Corrie A M Marijnen
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Lancet. Oncology     Volume:  9     ISSN:  1474-5488     ISO Abbreviation:  Lancet Oncol.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-02     Completed Date:  2008-05-15     Revised Date:  2014-08-18    
Medline Journal Info:
Nlm Unique ID:  100957246     Medline TA:  Lancet Oncol     Country:  England    
Other Details:
Languages:  eng     Pagination:  494-501     Citation Subset:  IM    
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MeSH Terms
Age Distribution
Age Factors
Aged, 80 and over
Anastomosis, Surgical / adverse effects
Digestive System Surgical Procedures / adverse effects
Health Services for the Aged*
Middle Aged
Neoadjuvant Therapy
Netherlands / epidemiology
Patient Selection*
Radiotherapy, Adjuvant
Rectal Neoplasms / mortality,  radiotherapy,  surgery*
Rectum / radiation effects,  surgery*
Risk Assessment
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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