Palliative Surgery for Oncologic Elderly Patients in Emergency

Aging is a major risk factor for cancer, and this population is growing fast. Elderly patients are a very heterogeneous group including both fit and frail individuals. Medical research generally aims at disease-free survival whether quality of life becomes a primary outcome for this group of patients, and the palliation of symptoms gains importance, in order to provide the best possible residual life. The evaluation must comprise a multidisciplinary approach with the use of various clinical performances’ and risk scales. In this chapter, we will analyze the role of palliative surgery in emergency, with a particular attention to minimally invasive surgery in obstructing colon cancer, gastric bleeding or gastric outlet syndrome, and biliary or duodenal obstructions in pancreatic cancer. Malignant bowel obstruction can occur in colorectal cancer, small bowel cancer, and peritoneal carcinosis. The therapeutic alternatives to radical or palliative resection are ostomies, internal bypass, or endoscopic stenting. The gastric tumor bleeding can be treated by endoscopy, embolization of gastric vessels, or emergency resection. The treatment of duodenal obstruction in gastric cancer comprehends stent placement, gastrojejunostomy, or nutritional enterostomy.