**Abstract**

Life expectancy has been increasing, and an increasing number of older patients are presenting with colorectal cancer. Surgical management of colorectal cancer in these patients poses a unique challenge, requiring a multidisciplinary team approach, as they have more comorbidities and lower functional reserves. An accurate diagnosis, a thorough patient assessment and individualized treatment is crucial in order to achieve the best possible outcome. While the overall postoperative mortality rates were significantly higher in the over 75 age group, it seems that age itself is not a risk factor for surgery. Older patients presented with more locally advanced disease, a factor that increased the overall postoperative mortality. Comorbid conditions increase the risk of postoperative mortality in these patients. When comparing different age groups with similar American Society of Anesthesiologists (ASA) scores, no significant difference was found in postoperative mortality. Laparoscopic surgery was shown to be beneficial for the elderly, with low morbidity and mortality and a shortened hospital stay. Patients with rectal cancer benefit from transanal endoscopic surgery as a primary procedure or as part of a 'watch and wait' strategy following neoadjuvant chemoradiotherapy. Early elective surgery and the avoidance of emergency major surgery whenever possible, by for example the use of stents followed by elective resection in cases of colonic obstruction, will help improve outcomes.

**Keywords:** surgery, colorectal cancer, rectal cancer, older patients, laparoscopic surgery, endorectal surgery

## **1. Introduction**

Colorectal cancer (CRC) is the third most common cancer worldwide, and the second leading cause of cancer-related deaths. Approximately 1.8 million new cases of CRC and 900,000 colorectal cancer-related deaths were recorded in 2018. The incidence of CRC is increasing worldwide. About 60% of CRC patients are over the age of 70 years at diagnosis, and about 40% are aged over 75 years [1].

The global population is aging. In fact, according to the World Health Organization, 11% of the world's population was over 60 years old in 2006, with an expected rise to 22% by 2050. A majority of these elderly patients are frail and have a number of comorbid illnesses and lower functional reserves, as well as potential psychological and social care issues [2].

Surgical resection is the standard treatment for CRC. The surgical management of these patients is challenging, requiring a multidisciplinary team approach. An

accurate diagnosis, a thorough patient assessment and individualized treatment is crucial in order to achieve the best possible outcome.
