According to the Australian Bureau of Statistics, in 2007 13% of Australians were over 65 years of age and 1.6% were over 85 years of age. According to conservative projections, by 2056 these figures are expected double to 24% for the over 65 years group and undergo a quadrupling of the 85+year old group to 7.3% of the Australian population. Colorectal cancer has a higher incidence in the older population, with the risk of developing CRC in the next 10 years being 1 in 100 at age 50 and 1 in 30 at age 70.

These data, when combined, suggest a significant increase in the colorectal cancer burden in Australia in the next 40 years. This burden may be lessened by early detection through the National Bowel Cancer Screening Program and with increased awareness and modification of lifestyle risk factors over the next decades. It is nevertheless likely that colorectal surgeons and oncologists will be called upon to manage more elderly colorectal cancer patients in the future.

The challenges for the colorectal surgeon in this setting begin with the first interview.  Expectations of patient and family need to be manage carefully and realistically, indeed a risk:benefit analysis may suggest that surgery is contraindicated, particularly if asymptomatic or if there is metastatic disease.

If surgery is to be performed, elderly patients create unique challenges in the setting of major abdominal surgery. There are likely to be more co-morbidities, with cardiovascular, peripheral vascular, respiratory and renal diseases all increasing in incidence with age. Such co-morbidities, as well as decreased tissue quality with age, have the potential to impact on the incidence of major complications such as anastomotic dehisicence and wound breakdown.

This paper will explore the challenges of providing colorectal surgical services to our ageing population, from the initial interview through the perioperative period and into a discussion of appropriate follow up after colorectal cancer in the elderly.