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Comparison of Non-operative Versus Operative Management of Resectable Colorectal Cancer in Elderly Patients: A Systematic Review


 Background: In 2010, 1.3 million Canadians were aged 80 and older. This number is expected to more than double to 3.3 million by 2036. Colorectal cancer (CRC) is the third most common cancer in both men and women, with its highest incidence rate in septu- and octogenarians. As clinicians encounter a growing number of very elderly patients (80 years and older) with resectable colorectal cancer, justifying major surgery in a comorbid population with limited life expectancy is difficult. Therefore, this study aims to systemically review the available literature to compare non-operative management to surgical resection with respect to overall survival and quality of life. Method: A systematic review will be conducted, in accordance with the PRISMA guideline. We will search MEDLINE, EMBASE and the Cochrane Database of Controlled Trials from 2000 to 2020 with the assistance of a health information specialist and clinical expert in the field of colorectal surgery.Discussion: The goal of this review is twofold: to synthesize the existing data on management of colorectal cancer in the very elderly patients, and identify the gap in the literature for potential future research. More specifically, we aim to streamline non-operative outcome data on resectable colorectal cancers to aid clinicians’ decision making with respect to survival outcomes and quality of life. We foresee challenges with this study, for example, we expect a lack of outcome data with regards to non-operative management of resectable, as well we also envision large degrees of heterogeneity with retrospective data and suboptimal study designs. In addition, outcomes such as quality of life and change of level of care lack widely recognised assessment tools, which will render comparisons difficult. Ultimately, despite these challenges, this review will serve to synthesize the existing data and lay the groundwork for future research. Systematic review registration: PROSPERO. Registration number: CRD42020199509