Surgery in the Aged Population

Monson, Keith M.; Litvak, David A.; Bold, Richard J.

doi:10.1001/archsurg.138.10.1061

Cited by 73 publications

(38 citation statements)

References 80 publications

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“…In our study, the median age of the patients was 71 years and did not represent a specific inconvenience for this type of surgery. Recent reports have shown that selected elderly patients benefit from colorectal surgery [15,16]. …”

Section: Discussionmentioning

confidence: 99%

Multivisceral Resection for Colon Cancer: Analysis of Prognostic Factors

López‐Cano

Mañas²,

Hermosilla³

et al. 2010

Dig Surg

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Background/Aims: To assess outcome of multivisceral resection in colon cancer patients and to identify predictors of survival. Methods: One hundred and thirteen consecutive patients with primary locally advanced colon cancer infiltrating adjacent organs undergoing multivisceral resection between 1998 and 2007 were reviewed. Overall survival and disease-free survival were analyzed by the Kaplan-Meier method. The relative risk for clinical outcome was obtained using a Cox multivariate model. Results: The median follow-up was 74.9 months. Fifty-two patients had sigmoid tumors and 48 involvement of the small intestine. Complications occurred in 54 patients. The diagnosis was conventional adenocarcinoma in 94 patients. R0 resection was achieved in 96 patients (85%). Eighty-three patients received postoperative adjuvant therapy. The operative mortality was 7.1% (8 patients). Sixty-seven patients died at follow-up. Of the 46 patients who were alive, 38 were free of disease. In 73 patients with pT4a disease, 42 patients died (57.5%) and of the 31 survivors, recurrence was documented in 6. Hematochezia and adjuvant chemotherapy were independent factors of favorable outcome and grade G3 and tumor stage III–IV of poor survival. Conclusion: Hematochezia and adjuvant chemotherapy were associated with a better survival, and poorly differentiated tumors and stage IV disease with a poor survival.

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Section: Discussionmentioning

confidence: 99%

Multivisceral Resection for Colon Cancer: Analysis of Prognostic Factors

López‐Cano

Mañas²,

Hermosilla³

et al. 2010

Dig Surg

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“…Worldwide, the number of people of this age is increasing at an unprecedented rate, and most of this increase is occurring in developed countries [1,2]. The Japanese have the longest healthy life expectancy in the world: 82.02 y (males 78.67, females 85.56), based on a new way to calculate healthy life expectancy developed by the WHO.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy-Assisted Gastrectomy in Patients Older Than 80

Yamada¹,

Kojima²,

Inokuchi³

et al. 2010

Journal of Surgical Research

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“…Cancer, which is estimated to bypass cardiac disease as a cause of death within the near future [1], occurs predominantly in the aged people. This leads to a steady increase of the oncogeriatric population.…”

Section: Introduction and Aim Of The Studymentioning

confidence: 99%

Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years☆

Internullo

Moons

Nafteux

et al. 2008

European Journal of Cardio-Thoracic Surgery

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Objective: Though the surgical treatment of esophageal cancer is increasingly accepted for elderly people defined as aged over 70 years, less is reported about the results in patients over 75. This study is a single institution retrospective analysis of outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Methods: All consecutive patients 76 years old and over undergoing curative esophagectomy for cancer in the period 1991-2006 were analyzed as to comorbidities, outcome and long-term survival. All the data had been prospectively collected in a database. Postoperative mortality risk was assessed by P-POSSUM and O-POSSUM score for in-hospital mortality and by the recently published Steyerberg's score system [Steyerberg EW, Neville BA, Koppert LB, Lemmens VEPP, Tilanus HW, Coebergh JWW, Weeks JC, Earle CC. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24:4277-84.] for 30-day mortality. Five-year survival was compared to the standardized survival in the general population. Results: One hundred and eight patients fulfilling the abovementioned criteria were found (76 males and 32 females, mean age 79.5 years, mean standardized life-expectancy: 7.36 years). Among them, 69% had esophageal tumors and 31% GEJ tumors. The predominant histology was adenocarcinoma (74%). Eighty-six (79.6%) presented with one or more major comorbidities or a history of previous major upper-GI surgery, potentially affecting the surgical outcome. All underwent resection with curative intent (R 0 83.3%, R 1 12%, R 2 4.6%). The overall postoperative morbidity rate was 51.9%, pulmonary complications (37%) being the most frequent. Postoperative mortality, mainly due to cardiopulmonary complications, was 7.4%, which was consistent with that predicted by P-POSSUM score (7.2%) and lower than that predicted by O-POSSUM score (15.1%). Thirty-day mortality was 5.5%, being consistent with that predicted by the Steyerberg's score (6.8%). Overall 5-year survival was 35.7%, while R 0 overall survival 42% and cancer specific R 0 survival 51.7%. Conclusions: Patients 76 years old and over with esophageal or GEJ cancer should not be denied surgery solely on the basis of age. Outcome and long-term results in the selected elderly are not differing from those reported for younger patients. However, despite thorough preoperative assessment being applied in the selection of the candidates for surgery, a practical and reliable individual riskanalysis stratification is still lacking. #

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Surgery in the Aged Population

Cited by 73 publications

References 80 publications

Multivisceral Resection for Colon Cancer: Analysis of Prognostic Factors

Multivisceral Resection for Colon Cancer: Analysis of Prognostic Factors

Laparoscopy-Assisted Gastrectomy in Patients Older Than 80

Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years☆

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