{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:09:47Z","timestamp":1778821787286,"version":"3.51.4"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The progressive aging of the global population has led to a substantial increase in colorectal cancer (CRC) incidence among very elderly individuals. Patients aged \u226580 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u226580 years. Evidence was synthesized into pragmatic clinical frameworks integrating oncologic and geriatric principles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Emergency CRC in patients aged \u226580 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1816546","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T04:28:44Z","timestamp":1778819324000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Emergency colorectal cancer in old and very elderly patients: a narrative review"],"prefix":"10.3389","volume":"16","author":[{"given":"Carlo","family":"Bergamini","sequence":"first","affiliation":[{"name":"Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital","place":["Florence, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacopo","family":"Martellucci","sequence":"additional","affiliation":[{"name":"Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital","place":["Florence, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davina","family":"Perini","sequence":"additional","affiliation":[{"name":"Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital","place":["Florence, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Prosperi","sequence":"additional","affiliation":[{"name":"Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital","place":["Florence, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessio","family":"Giordano","sequence":"additional","affiliation":[{"name":"Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital","place":["Florence, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2016.421","article-title":"The impact of age on complications, survival, and cause of death following colon cancer surgery","volume":"116","author":"Aquina","year":"2017","journal-title":"Br J Cancer"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/wjs.70106","article-title":"Acute presentations of colorectal cancer: an international prospective snapshot on management and outcomes","volume":"49","year":"2025","journal-title":"World J Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2015.49","article-title":"Stage at diagnosis and early mortality from cancer in England","volume":"112","author":"McPhail","year":"2015","journal-title":"Br J Cancer"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2019\/e1074","article-title":"Outcomes of elderly patients undergoing emergency surgery for complicated colorectal cancer: a retrospective cohort study","volume":"74","author":"Menegozzo","year":"2019","journal-title":"Clinics (Sao Paulo)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1007\/s00423-023-03201-y","article-title":"Colorectal cancer surgery in octogenarians: real-world long-term results","volume":"409","author":"Willemsen","year":"2023","journal-title":"Langenbecks Arch Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2019.06.017","article-title":"GOSAFE - Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery: early analysis on 977 patients","volume":"11","author":"Montroni","year":"2020","journal-title":"J Geriatr Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s12094-023-03243-0","article-title":"Update on the management of elderly patients with colorectal cancer","volume":"26","author":"Soler-Gonz\u00e1lez","year":"2024","journal-title":"Clin Transl Oncol"},{"key":"B8","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMp1109283","article-title":"Shared decision making\u2014the pinnacle of patient-centered care","volume":"366","author":"Barry","year":"2012","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2023.1251461","article-title":"Oncological and surgical outcomes of radical surgery in elderly colorectal cancer patients with intestinal obstruction","volume":"10","author":"Ma","year":"2023","journal-title":"Front Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e247057","DOI":"10.6004\/jnccn.2024.7057","article-title":"Evolution in the management of left-sided obstructive colon cancer in the Netherlands during a 9-year period","volume":"22","author":"Sijmons","year":"2024","journal-title":"J Natl Compr Canc Netw"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17091522","article-title":"Malignant bowel occlusion: an update on current available treatments","volume":"17","author":"Neri","year":"2025","journal-title":"Cancers (Basel)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-016-5315-x","article-title":"The role of stents in the management of colorectal complications: a systematic review","volume":"31","author":"Arezzo","year":"2017","journal-title":"Surg Endosc"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.23736\/S0026-4733.20.08299-1","article-title":"Obstructive left side colon cancer: time for a tailored operative approach","volume":"75","author":"Bergamini","year":"2020","journal-title":"Minerva Chir"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1055\/a-0591-2883","article-title":"Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis","volume":"6","author":"Ribeiro","year":"2018","journal-title":"Endosc Int Open"},{"key":"B15","doi-asserted-by":"publisher","first-page":"7","DOI":"10.23736\/S2724-5691.23.09969-0","article-title":"Colonic resection, stoma, or self-expanding metal stents for obstructive left colon cancer: the CROSCO-1 study protocol","volume":"79","author":"Giordano","year":"2024","journal-title":"Minerva Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s13017-018-0192-3","article-title":"WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation","volume":"13","author":"Pisano","year":"2017","journal-title":"World J Emerg Surg"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-5691.23.10165-1","article-title":"The management of complicated colorectal cancer in older patients in a global perspective after COVID-19: the CO-OLDER WSES project","volume":"79","author":"Simone B","year":"2024","journal-title":"Minerva Surg"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.5043","article-title":"Long-term postprocedural outcomes of palliative emergency stenting vs stoma in malignant large-bowel obstruction","volume":"152","author":"Abelson","year":"2017","journal-title":"JAMA Surg"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2013.4059","article-title":"Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review","volume":"149","author":"Paul Olson","year":"2014","journal-title":"JAMA Surg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2025.1649766","article-title":"Mortality risk prediction in octogenarians undergoing emergency colorectal surgery: a tertiary center experience and systematic review of the literature","volume":"12","author":"Brolese","year":"2025","journal-title":"Front Surg"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.21873\/invivo.12213","article-title":"Cancer surgery in patients older than 80 years: is hartmann's procedure safe","volume":"34","author":"Iguchi","year":"2020","journal-title":"In Vivo"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14010126","article-title":"Surgical emergencies in rectal cancer: a narrative review","volume":"14","author":"Pajola","year":"2024","journal-title":"J Clin Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s13017-024-00551-w","article-title":"Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use","volume":"19","author":"Sartelli","year":"2024","journal-title":"World J Emerg Surg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for sepsis and septic shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-020-03784-8","article-title":"The role of damage control surgery in the treatment of perforated colonic diverticulitis: a systematic review and meta-analysis","volume":"36","author":"Cirocchi","year":"2021","journal-title":"Int J Colorectal Dis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1007\/s00423-025-03693-w","article-title":"Open abdomen versus primary closure in the management of severe abdominal sepsis: What is the right way? Results of the last 5 years of a reference center","volume":"410","author":"Guagni","year":"2025","journal-title":"Langenbecks Arch Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e232298","DOI":"10.1148\/radiol.232298","article-title":"The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations","volume":"310","author":"Sengupta","year":"2024","journal-title":"Radiology."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.959650","volume":"12","author":"Turri","year":"2022","journal-title":"Front Oncol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1186\/s13017-021-00378-9","article-title":"Multidisciplinary management of elderly patients with rectal cancer: recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project","volume":"16","author":"Podda","year":"2021","journal-title":"World J Emerg Surg"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2024.101780","article-title":"Emergency presentation of colorectal cancer in older adults: A retrospective cohort analysis","volume":"15","author":"Nobes","year":"2024","journal-title":"J Geriatr Oncol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2019\/e1074","article-title":"Outcomes of Elderly Patients Undergoing Emergency Surgery for Complicated Colorectal Cancer: A Retrospective Cohort Study","volume":"74","author":"Menegozzo","year":"2019","journal-title":"Clinics (Sao Paulo)"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol32120652","article-title":"Outcomes Following Colorectal Cancer Resection in Elderly Patients","volume":"32","author":"Grainger","year":"2025","journal-title":"Curr Oncol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e0243995","DOI":"10.1371\/journal.pone.0243995","article-title":"The impact of comorbidities on post-operative complications following colorectal cancer surgery","volume":"15","author":"Flynn","year":"2020","journal-title":"PloS One"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2301292","article-title":"Frailty in older adults","volume":"391","author":"Kim","year":"2024","journal-title":"N Engl J Med"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-023-13696-w","article-title":"Preoperative Frailty Assessment Predicts Postoperative Mortality, Delirium and Pneumonia in Elderly Lung Cancer Patients: A Retrospective Cohort Study","volume":"30","author":"Tian","year":"2023","journal-title":"Ann Surg Oncol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-5691.24.10274-2","article-title":"Futility and life expectancy: an increasing ethical and clinical challenge in emergency surgery","volume":"79","author":"Giordano","year":"2024","journal-title":"Minerva Surg"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgo.2024.101836","article-title":"Age-specific impact of comorbidity on postoperative outcomes in older patients with colorectal cancer","volume":"15","author":"van der Hulst","year":"2024","journal-title":"J Geriatr Oncol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdu253","article-title":"Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013","volume":"26","author":"Papamichael","year":"2015","journal-title":"Ann Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1816546\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T04:28:44Z","timestamp":1778819324000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1816546\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":38,"alternative-id":["10.3389\/fonc.2026.1816546"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1816546","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]},"article-number":"1816546"}}