Provisional Clinical Opinions (PCOs) Recommended by the Surgical Treatment Working Group for Vulnerable Elderly Patients inColorectal Cancer: General Remarks on Surgical Treatment

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  • Tanaka Chie
    Department of Gastroenterological Surgery, Nagoya University School of Medicine
  • Mizuno Ju
    Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine
  • Nishimura Junichi
    Department of Gastroenterological Surgery, Osaka International Cancer Institute
  • Matsuda Keiji
    Department of Surgery, Teikyo University School of Medicine
  • Murata Kohei
    Department of Surgery, Kansai Rosai Hospital
  • Oka Shiro
    Department of Gastroenterology and Metabolism, Hiroshima University Hospital
  • Yoshida Yoshio
    Department of Obstetrics and Gynecology, University of Fukui
  • Yoshida Yoichiro
    Department of Gastroenterological Surgery, Fukuoka University School of Medicine

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  • 「プレフレイル高齢大腸がん患者のための臨床的提言」外科治療に関する提言─総論─

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Abstract

<p>Here we report the guidelines for surgical intervention on vulnerable elderly patients with colorectal cancer. Appropriate preoperative and intraoperative evaluations are important when performing surgery to treat elderly patients with colorectal cancer. Preoperative risk factors including deterioration of physical and cognitive function, malnutrition, comorbidities, polypharmacy, and decreases in skeletal muscle mass are associated with increased rates of postoperative complications and death. Limiting intraoperative fluid administration, fluid management based on goal-directed therapy (GDT), and anesthesia-depth management using EEG monitoring to prevent hypothermia, cutaneous injury, muscular damage, neuropathy, and circulatory disturbance lead to reduced postoperative complications. However, there are insufficient data to establish a clinically significant association between risk factors and postoperative complications. Moreover, there are no data to determine if surgical intervention results in acceptable outcomes for vulnerable patients who undergo invasive surgery and who are poor candidates for standard treatment. In order to solve these problems, it is necessary to accumulate and analyze data based on comprehensive geriatric assessment (CGA).</p>

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