Emergency colorectal cancer in old and very elderly patients: a narrative review.

INTRODUCTION

The progressive aging of the global population has led to a substantial increase in colorectal cancer (CRC) incidence among very elderly individuals. Patients aged ≥80 years represent a highly vulnerable subgroup characterized by frailty, multimorbidity, reduced physiological reserve, and a high likelihood of emergency presentation. Management of CRC emergencies in this population requires individualized decision-making that balances oncologic radicality with functional preservation and patient-centered goals.

METHODS

A structured narrative review was conducted using PubMed, Embase, and Scopus. Studies addressing emergency presentation and management of CRC in elderly and very elderly patients were analyzed, with specific focus on populations aged ≥80 years. Evidence was synthesized into pragmatic clinical frameworks integrating oncologic and geriatric principles.

RESULTS

Emergency CRC presentation occurs in up to 46% of colon cancers among patients older than 80 years and is consistently associated with worse short- and long-term survival. Malignant bowel obstruction is the most frequent emergency scenario. Bridge-to-surgery strategies, including self-expanding metal stents (SEMS) or diverting stomas, significantly reduce early mortality compared with emergency resection in selected elderly patients. Perforation and septic complications require damage-control approaches prioritizing rapid source control and physiological stabilization. Frailty and comorbidity burden are major independent prognostic determinants across all emergency presentations.

CONCLUSIONS

Emergency CRC in patients aged ≥80 years represents a high-risk clinical scenario requiring integration of oncologic rigor with geriatric-oriented care. Future research should prioritize geriatric-specific endpoints, predictive frailty-based triage models, and real-world functional outcomes. These findings highlight the urgent need for geriatric-tailored emergency surgical pathways.