Textbook oncologic outcomes in elderly patients undergoing neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer: a multicenter study - Report - MDSpire
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Textbook oncologic outcomes in elderly patients undergoing neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer: a multicenter study
Outcomes of Neoadjuvant Chemoradiotherapy and Surgery in Older Adults with Locally Advanced Rectal Cancer
Overview
In a multicenter study of 157 elderly patients (≥70 years) with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by surgery, 98% achieved R0 resection with low severe complication rates and no 90-day mortality. The study highlights the feasibility and safety of this multimodal approach in older adults, with a median hospital stay of 8 days and a high rate of ileostomy reversal.
Background
Colorectal cancer is a leading cause of cancer-related death worldwide, with a rising incidence in the elderly population. Locally advanced rectal cancer (LARC) is commonly treated with neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME), improving oncologic outcomes. However, older patients often face challenges such as comorbidities and frailty that may limit treatment intensity and affect survival. The Textbook Oncologic Outcome (TOO) metric integrates surgical and oncologic quality indicators to assess treatment success, but its application in elderly LARC patients remains underexplored.
Data Highlights
Characteristic
Value
Number of patients
157
Median age (years)
75 (IQR 72–78)
Clinical T stage
cT2: 4.5%, cT3: 76%, cT4: 19%
Nodal involvement
88%
Median tumor distance from anal verge (cm)
7.0 (IQR 5.0–9.0)
Minimally invasive surgery
58%
Conversion to open surgery
6.2%
Ostomy creation
99% (96.7% ileostomy, 3.3% colostomy)
Ileostomy reversal rate
77%
Median time to ileostomy reversal (days)
174 (IQR 87–263)
Median length of stay (days)
8 (IQR 7–11)
Severe complications (Clavien-Dindo ≥3b)
8.9%
90-day mortality
0%
R0 resection rate
98%
Median lymph nodes harvested
13 (IQR 8–17)
Key Findings
Neoadjuvant chemoradiotherapy followed by low anterior resection is feasible and safe in patients aged ≥70 years with locally advanced rectal cancer.
R0 resection was achieved in 98% of patients, indicating excellent surgical oncologic quality.
Severe postoperative complications occurred in less than 9% of patients, with no 90-day mortality reported.
Minimally invasive surgery was utilized in over half of cases, with a low conversion rate to open surgery (6.2%).
Ostomy creation was nearly universal, predominantly ileostomy, with a 77% reversal rate at a median of 174 days post-surgery.
The median hospital length of stay was 8 days, reflecting efficient postoperative recovery.
Clinical Implications
This study supports the use of standard multimodal treatment including nCRT and surgery in elderly patients with LARC, demonstrating that advanced age alone should not preclude curative intent therapy. Minimally invasive surgical approaches can be safely employed with low morbidity. Careful patient selection and perioperative management can optimize outcomes and facilitate ileostomy reversal in this population.
Conclusion
Multimodal treatment with neoadjuvant chemoradiotherapy followed by surgery yields favorable oncologic and surgical outcomes in elderly patients with locally advanced rectal cancer. The findings underscore the importance of applying guideline-concordant care to improve survival and quality of life in this growing patient group.
References
Italian expert consensus on colorectal surgery TOO criteria, 2023
