Differentiated approach to surgical treatment of сolorectal cancer and comorbid pathology

Colorectal cancer (CRC) is one of the most common types of cancer worldwide. It ranks 3rd in the structure of the total oncological incidence and in the vast majority of cases is detected in people ≥65 years of age. Patients of this age are often found to have several chronic diseases that aggravate the outcomes of surgical treatment of CRC. The aim of this study was to identify the main comorbid diseases that significantly affect the outcome of surgical treatment of patients with CRC with the determination of the specifics of the management tactics for these categories of patients. The conducted system analysis showed that the frequency of detection of comorbid diseases in patients with CRC is 28.0% (4053/14473). The most common comorbidities are diseases of the gastrointestinal tract — 55% (279/505 patients), diabetes mellitus — 50% (1923/3825 patients), cardiovascular diseases — 42% (1469/3519 patients). The incidence of postoperative non-surgical complications in patients with CRC and comorbid pathology is 33% (53/162 patients), and postoperative mortality is 13% (31/242 patients). The most frequently identified cardiac complications (42% — 47/162 patients). Among comorbid diseases, a special role is given to coronary heart disease, severe cardiac arrhythmias, chronic obstructive pulmonary disease and diabetes mellitus. An analysis of scientific papers has shown that the presence of comorbid pathology including in geriatric patients is not a contraindication to surgical intervention for CRC. However, this category of patients in the perioperative period needs a differentiated and personalized approach regarding the benefits and risks of the necessary medical interventions.