ASCRS Ch67 - Considerations for Geriatric Patients Undergoing Colorectal Surgery

Chapter 67 of the ASCRS Textbook of Colon and Rectal Surgery, 4th edition (Saur NM, Wilkins KB), book pages 1105-1116 (PDF pages 1088-1099, offset +17). Part of a "Special Populations"-style grouping alongside the immediately preceding ASCRS Ch66 - Pediatric Colorectal Disorders.

Structure

• Introduction: epidemiology of colorectal cancer in patients >65; life-expectancy-by-comorbidity framing.
• Frailty Screening: comprehensive geriatric assessment (CGA) as gold standard; Table 67.1 summarizing eight screening tools (ECOG PS, ADLs, Mini-Cog, fTRST, TUG, G8, NRS, ASA, CACI).
• Domains of Geriatric Assessment: functional (TUG, ADLs), cognitive (Mini-Cog), polypharmacy, nutrition, social support, patient's wishes.
• Prehabilitation: multidimensional programs (medical, exercise, nutritional, psychological); Minnella et al., Gillis et al., Carli et al. findings on response heterogeneity and timing.
• Surgical Considerations: enhanced recovery pathway elements, MIS appropriateness, emergency surgery outcomes and fTRST's ED-setting validation (Zattoni et al.), explicit guidance against age-based bias toward palliative lesser operations.
• Postoperative Management: geriatric comanagement (Shahrokni et al.), delirium risk factors and prevention (OR 0.47 for multifactorial nonpharmacologic intervention), rehabilitation.
• Functional Recovery and Patient-Reported Outcomes: GOSAFE study, ICHOM PROM domains (Fig. 67.2, Doolin et al.), LARS score and Cleveland Clinic Fecal Incontinence Score as validated instruments, colostomy-vs-coloanal-anastomosis decision-making in patients with poor baseline sphincter tone.
• Personalized Treatment of Rectal Cancer: 29-member interdisciplinary task force recommendations (ESSO/ESCP/SIOG/ACS CoC, Montroni et al.) — Table 67.2 summarizes general recommendations, MDT frailty-based stratification, patient optimization, surgical treatment (TME approaches, local excision, surgical emergencies), treatment of locally advanced disease (neoadjuvant CRT, contact X-ray brachytherapy, watch and wait, adjuvant chemotherapy not advised), treatment of synchronous liver metastases, and outcomes (ERAS, functional recovery, PROMs, healthcare cost); Fig. 67.3 proposed treatment algorithm stratified by fit vs. frail/vulnerable status; Fig. 67.4 life-expectancy data showing modern surgical outcomes approach that of peers without rectal cancer.
• Conclusions.
• References (56 citations).

Wiki disposition

Written to a new dedicated concept page, Geriatric Considerations in Colorectal Surgery, rather than folded into the existing Preoperative Evaluation & Perioperative Risk Optimization or Enhanced Recovery After Surgery (ERAS) pages — this chapter's geriatric-oncology-specific screening tools, functional-recovery/PROM framework, and especially its rectal-cancer-specific treatment algorithm go substantially beyond the elderly/frailty content already present on those two general perioperative-medicine pages (sourced from ASCRS Ch. 6 and Ch. 7 respectively). Cross-linked from both pages and from Rectal Cancer, Low Anterior Resection Syndrome (LARS), Total Mesorectal Excision (TME) & Sphincter-Sparing Resection, and Local Excision of Rectal Neoplasms.

Offset verification

Chapter opens on book page 1105 (PDF page 1088), copyright line confirms "© Springer Nature Switzerland AG 2022 1105" — offset +17, unchanged from Ch. 66. Chapter ends on book page 1116 (even page); no Part-divider or blank-verso jump occurs at the Ch. 67/Ch. 68 boundary — Ch. 68 ("Healthcare Economics," Peters WR, deBeche-Adams T) confirmed starting at book page 1117 (PDF page 1100), offset +17 unchanged.