Laparoscopic Resection for Rectal Cancer in a Centenarian: A Case Report Highlighting the Importance of Functional Independence over Chronological Age

Abstract

INTRODUCTION: Laparoscopic resection for rectal cancer in a centenarian is extraordinarily rare, with only a few cases of elective curative surgery reported worldwide. As the global population ages, the number of centenarians with malignancies is increasing; however, surgical intervention in this age group remains controversial due to frailty and limited physiological reserve.

CASE PRESENTATION: We present the case of a 100-year-old female with Stage IIIB rectal cancer who successfully underwent elective laparoscopic low anterior resection. Comprehensive preoperative geriatric assessments—comprising the Geriatric-8 (G8), instrumental activities of daily living (IADL), and EuroQol-5 dimensions (EQ-5D and EQ-VAS)—demonstrated excellent functional independence and physiological fitness. Despite severe intra-abdominal adhesions from a prior laparotomy, meticulous laparoscopic adhesiolysis and tumor-specific mesorectal excision were achieved without complications. Twelve lymph nodes were retrieved, with one positive node, and all resection margins were negative. The patient recovered uneventfully, retained postoperative independence, and was discharged on POD 12.

CONCLUSIONS: This case highlights that functional and biological fitness—rather than chronological age—should guide surgical decision-making in the oldest-old population. It also underscores the feasibility and safety of minimally invasive curative surgery for selected centenarians when supported by detailed geriatric evaluation and multidisciplinary planning.