Risk Factors for Adverse Outcome for Elderly Patients undergoing Curative Oncological Resection for Gastrointestinal Malignancies

Abstract

Background: The incidence of gastrointestinal cancer increases with age, with approximately 20% of these cases in people over 80 years of age. Due to pre-existing comorbidities, this onco-geriatric population often presents diagnostic and therapeutic challenges. Methods: A systematic review of articles on PubMed was performed to determine the predictive ability of screening tools and their components regarding the occurrence of adverse outcomes in elderly onco-surgical patients with gastrointestinal malignancies. Results: Surgical procedures in this patient cohort, particularly complex resections, may result in increased morbidity and mortality. The decision to treat an elderly patient with curative intent requires sound clinical judgment based on knowledge, consideration of objective parameters, and experience. These patients could potentially be optimized for surgery with the improvement of nutritional and overall performance status as well as with stabilizing comorbidities. Conclusion: Various geriatric assessment and screening tools have been developed to identify risk factors to assist the surgeon and the interdisciplinary team in treatment planning, including the Frailty Assessment Score, Timed Up and Go test, nutritional status, and Activities of Daily Living test. It is important to emphasize that transparent and open communication between the treating surgeon and the patient is crucial in that the patient fully understands the implications of the treatment plan.

Minimally invasive treatment of postoperative fistulas, leakages, and perforations of the upper gastrointestinal tract: a single-center observational study.

“…In obesity the risk of dehiscence occurs as a result of difficult technical conditions as well as a temporary decrease in immunity. As the age above 70 significantly increases the risk of postoperative complications, the group of elderly patients should also be referred for surgery with special precautions [ 17 , 18 ].…”

Challenges in Decision Making in Elderly Patients with Gastrointestinal Malignancies

“…The predictive ability of various screening tools and their components were analyzed. However, future research is needed to assess the significance of prehabilitation and improvement of nutritional status prior to surgery in elderly patient outcomes [2]. The Surgical Task Force of the International Society of Geriatric Oncology (SIOG) performed a survey of surgical oncologists in Europe and the USA to determine their treatment approach for elderly cancer patients.…”