Predictors of Short-Term Postoperative Survival After Elective Colectomy in Colon Cancer Patients ≥80 Years of Age

Background

Individuals ≥80 years of age represent an increasing proportion of colon cancer diagnoses. Selecting these patients for elective surgery is challenging because of diminished overall health, functional decline, and limited data to guide decisions. The objective was to identify overall health measures that are predictive of poor survival after elective surgery in these oldest-old colon cancer patients.

Methods

Medicare beneficiaries ≥80 years who underwent elective colectomy for stage I–III colon cancer from 1992–2005 were identified from the Surveillance, Epidemiology and End Results(SEER)-Medicare database. Kaplan–Meier survival analysis determined 90-day and 1-year overall survival. Multivariable logistic regression assessed factors associated with short-term postoperative survival.

Results

Overall survival for the 12,979 oldest-old patients undergoing elective colectomy for colon cancer was 93.4 and 85.7 %, at 90 days and 1 year. Older age, male gender, frailty, increased hospitalizations in prior year, and dementia were most strongly associated with decreased survival. In addition, AJCC stage III (vs stage I) disease and widowed (vs married) were highly associated with decreased survival at 1 year. Although only 4.4 % of patients were considered frail, this had the strongest association with mortality, with an odds ratio of 8.4 (95 % confidence interval, 6.4–11.1).

Conclusions

Although most oldest-old colon cancer patients do well after elective colectomy, a significant proportion (6.6 %) die by postoperative day 90 and frailty is the strongest predictor. The ability to identify frailty through billing claims is intriguing and suggests the potential to prospectively identify, through the electronic medical record, patients at highest risk of decreased survival.     

Presentation and Survival of Operable Esophageal Cancer in Patients 55 Years of Age and Below

Background  

The increased incidence of esophageal cancer, especially in the younger age group, should encourage early diagnosis. The perceived rarity and poor prognostic outcome of esophageal cancer in this group is based on retrospective studies. The goal of this study was to review the presentation and survival of young patients with esophageal cancer.     

Laparoscopic Gastric Bypass in Patients 60 Years and Older: Early Postoperative Morbidity and Resolution of Comorbidities

Background  

Bariatric surgery has not been routinely presented as an option for patients over 60 years of age. Part of the reason is the long-standing perception that there is additional risk. Additionally, until its recent ruling, Medicare was inconsistent in its coverage, thus making it difficult for some beneficiaries to gain access to the procedures. The aim of this study was to evaluate the perioperative morbidity in our patients who were 60 years of age or older who underwent a laparoscopic gastric bypass Roux-en-Y (LGBRY). We also report the impact of surgery on five objectively graded comorbidities in the early postoperative period.     

Outcomes of Laparoscopic Sleeve Gastrectomy in Patients Older than 60 Years

Background

Morbidity and mortality following laparoscopic sleeve gastrectomy (LSG) occur at acceptable rates, but its safety and efficacy in the elderly are unknown.

Methods

A retrospective review was performed of all patients aged >60 years who underwent LSG from 2008 to 2012. These patients were 1:2 matched, by gender and body mass index (BMI) to young patients, 18?<?age?<?50. Data analyzed included demographics, preoperative and postoperative BMI, postoperative complications, and improvement or resolution of obesity-related comorbidities.

Results

Fifty-two morbid obese patients older than 60 years underwent LSG (mean age, 62.9?±?0.3 years). These were matched to 104 young patients, age 18–50 years (mean age, 35.7?±?0.8 years). Groups did not differ in male gender (44 vs. 43 %, p?=?0.9), preoperative BMI (42.6?±?0.7 vs. 42.6?±?0.6, p?=?0.97), and length of follow-up (17?±?2 vs. 22?±?1.4 months, p?=?0.06). Obesity-related comorbidities were significantly higher in the older group (96 vs. 65 %, p?<?0.001). Excess weight loss (EWL) was higher in the younger group (75?±?2.4 vs. 62?±?3 %, p?=?0.001). Older patients had a significantly higher rate of a concurrent hiatal hernia repair (23 vs. 1.9 %, p?<?0.001). Overall postoperative minor complication rate was higher in the older group (25 vs. 4.8 %, p?<?0.001). This included atrial fibrillation (9.5 %), urinary tract infection (7 %), trocar site hernia (4 %), dysphagia, surgical site infection, bleeding, bowel obstruction, colitis, and nutritional deficiency (2 %, each). No perioperative mortality occurred. Comorbidity resolution or improvement was comparable between groups (88 vs. 80 %, p?=?0.13).

Conclusions

LSG is safe and very efficient in patients aged >60, despite higher rates of perioperative comorbidities.     

Perioperative Complications of Breast Cancer Surgery in Elderly Women (≥80 Years)

Purpose

There has been much controversy regarding the optimal management of breast cancer in very elderly women. Some clinicians are reluctant to offer surgical treatment for women older than aged 80 years because of the assumed higher operative risk associated with advanced age. This study was designed to investigate the perioperative complications of breast cancer surgery in women of this age group.

Methods

Data were reviewed of all women ≥80 years of age who underwent breast cancer surgery at a university clinic during the period 1990–2005. Symptoms, comorbidities, preoperative risk assessment, type of operation, postoperative histological diagnosis, hospital stay, morbidity, and mortality were documented and analyzed.

Results

During this 16-year period, 140 operations for breast cancer were performed in 129 women. The majority of the patients (37.9%) underwent a modified radical mastectomy, 32.1% underwent a simple mastectomy, 24.3% underwent breast-conserving therapy, and 5.7% underwent an axillary lymph node dissection. Complications occurred in 37.1% of the cohort: 31.4% were minor complications and only 5.7% were major. Intraoperative morbidity was 18.6% and postoperative morbidity was 20%. Late complications occurred in 5% of patients. The most common complications were associated with the wound region (50%). The perioperative mortality in this group of elderly women was zero.

Conclusions

Breast cancer surgery has acceptable perioperative morbidity and mortality in women aged ≥80 years. Surgery is the cornerstone of breast cancer treatment and should be offered as first-line treatment for all patients regardless of their age.     

Early Outcome Following Hepatic Resection in Patients Older Than 80?Years of Age

Background  We aimed to study the early outcome of patients 80 years of age and older undergoing liver resection and to compare the results with the outcomes of patients younger than 80 years of age. Methods  All 350 consecutive patients undergoing hepatic resections from 2004 April to 2008 October were included. Patients were divided into two groups: 80 years of age and older (group I; n = 43) and less than 80 years of age (group II; n = 307). Preoperative clinicopathological features, intraoperative factors, in-hospital mortality, postoperative complications, length of hospital stay, operative mortality, morbidity, and prognosis after discharge were analyzed and compared between groups I and II. Results  There was no significant difference between the two groups regarding the indication for hepatic resection. Hepatitis viral status was significantly different between groups: patients without hepatitis B or C viral infection were more common in group I than in group II. Regarding preoperative liver function, serum levels of albumin were significantly lower in group I than in group II. Although the operative time was significantly shorter in group I than in group II, no difference was found between groups regarding such operative factors as type of hepatectomy, blood loss, and rate of blood transfusion. After elimination of 16 patients with extrahepatic bile duct resection and reconstruction, no difference existed between the two groups in operative time. There was no postoperative mortality nor in-hospital mortality in group I; in group II one postoperative death (0.3%) and two in-hospital deaths (0.6%) were recorded. There was no difference between groups in the incidence of morbidity and early prognosis after discharge. Conclusions  The results indicate that hepatic resection for elderly patients over 80 can be safely performed given careful patient selection.     

Gastric Bypass in Older Patients: Complications,Weight Loss,and Resolution of Comorbidities at 2 Years in a Matched Controlled Study

Background

Roux-en-Y gastric bypass (RYGB) has recently been authorized for use in older patients. The objective of this single-center study was to evaluate 2-year weight loss in patients ≥60 years compared with younger matched patients undergoing RYGB. Secondary aims were to record complications and the resolution of comorbidities in a 2-year follow-up.

Methods

Of 722 patients with at least 2 years follow-up data, 48 elderly patients were matched with 92 young (<40 years) and 96 middle-aged (40–59 year) patients, according to sex, baseline body mass index, and date of surgery. Weight loss, remission of comorbidities, death, and early (30-day) and 2-year complication rates were compared.

Results

There were three deaths in the elderly group and none in the other groups. The early complication rate was not significantly different in the elderly group (17.8 %) compared with the young (11.5 %, p?=?0.637) and middle-aged (13.7 %, p?=?1.000) groups. The 2-year complication rates were not significantly different in the elderly group (9.3 %) compared with the young (23.5 %, p?=?0.107) and middle-aged (13.2 %, p?=?1.000) groups. The 2-year weight loss was lower in the elderly group (31.8?±?7.2 %; p?<?0.001) than in the young group (38.3?±?6.9 %) but was not significantly different from that in the middle-aged group (34.4?±?8.0 %; p?=?0.145). Remission rates for diabetes and obstructive sleep apnea were lower in the elderly than in the two younger groups.

Conclusion

After bariatric surgery, major weight loss was observed in patients older than 60, but remission of metabolic comorbidities was less marked than in younger subjects.

     

Complications Requiring Reoperation after Gastrectomy for Gastric Cancer: 17 Years Experience in a Single Institute

Introduction  Morbidity and mortality rates following gastric cancer surgery are still high. The present study documented complications requiring reoperation after gastrectomy for gastric cancer and described surgical management for each complication. Materials and Methods  Between 1987 and 2004, 8,033 patients underwent gastrectomy at the Department of Surgery, College of Medicine, Yonsei University, and the records were reviewed. Results and discussion  The most frequent complication was intestinal obstruction (88 patients, 54.3%), followed by intraabdominal bleeding (15, 9.3%), wound dehiscence or evisceration (15, 9.3%), incisional hernia (15, 9.3%), anastomotic leakage (seven, 4.2%), acalculous cholecystitis (five, 3.1%), duodenal stump leakage (five, 3.1%), intraabdominal abscess without leakage (five, 3.1%), bowel perforation (five, 3.1%), bile peritonitis due to hepatic duct injury (one, 0.6%), and biliary stricture (one, 0.6%). There were ten cases of hospital mortality (6.2%) from intraabdominal bleeding (four patients), intestinal obstruction (four patients), and anastomotic leakage (two patients). The most common long-term complication requiring reoperation was intestinal obstruction (69, 75.8%) due to adhesive formation rather than technical failure, while short-term complications were surgery-related and associated with high hospital mortality (14.1%). Conclusion  Proper preoperative preparation and faultless surgical skills are required during initial surgery to reduce complications and the need for reoperation. This work was done through the Yonsei Gastric Cancer Clinic, Severance Hospital, College of Medicine, Yonsei University, Seoul, South Korea.     

The Outcome of Bariatric Surgery in Patients Aged 75 years and Older

Background

Bariatric surgery has been shown to be safe and effective in patients aged 60–75 years; however, outcomes in patients aged 75 or older are undocumented.

Methods

Patients aged 75 years and older who underwent bariatric procedures in two academic centers between 2006 and 2015 were studied.

Results

A total of 19 patients aged 75 years and above were identified. Eleven (58%) were male, the median age was 76 years old (range 75–81), and the median preoperative body mass index (BMI) was 41.4 kg/m² (range 35.8–57.5). All of the bariatric procedures were primary procedures and performed laparoscopically: sleeve gastrectomy (SG) (n?=?11, 58%), adjustable gastric band (AGB) (n?=?4, 21%), Roux-en-Y gastric bypass (RYGB) (n?=?2, 11%), banded gastric plication (n?=?1, 5%), and gastric plication (n?=?1, 5%). The median operative time was 120 min (range 75–240), and the median length of stay was 2 days (range 1–7). Three patients (16%) developed postoperative atrial fibrillation which completely resolved at discharge. At 1 year, the median percentage of total weight loss (%TWL) was 18.4% (range 7.4–22.0). The 1-year %TWL varied among the bariatric procedures performed: SG (21%), RYGB (22%), AGB (7%), and gastric plication (8%). There were no 30-day readmissions, reoperations, or mortalities.

Conclusion

Our experience suggests that bariatric surgery in selected patients aged 75 years and older would be safe and effective despite being higher risk. Age alone should not be the limiting factor for selecting patients for bariatric surgery.

     

What Are the Complications,Survival, and Outcomes After Revision to Reverse Shoulder Arthroplasty in Patients Older Than 80 Years?

Clinical Orthopaedics and Related Research® - By the time patients with a failed shoulder arthroplasty require revision surgery, a substantial number are older than 80 years. The risk of...     

Bariatric Surgery Outcomes in Patients Aged 65 Years and Older at an American Society for Metabolic and Bariatric Surgery Center of Excellence

Background  

Although morbid obesity rates in patients ≥65 years of age are increasing, few centers have reported weight loss surgery outcomes in elderly patients, resulting in a paucity of literature on perioperative mortality and morbidity.     

ASO Visual Abstract: Cancer-Related Fatigue after Esophageal Cancer Surgery—Impact of Postoperative Complications

Annals of Surgical Oncology -     

Pathologic Features and Long-term Results in Early Gastric Cancer: Report of 116 Cases 8–13 Years after Surgery

One hundred sixteen patients who underwent surgery for early gastric cancer (EGC) at Careggi General Hospital in Florence between 1987 and 1992 were studied with regard to clinicopathologic features, incidence, and recurrence of the disease. The overall 5-year cumulative survival rate was 87.5%, and the disease-specific 5-year survival rate was 88.2%. EGC was limited to the mucosa in 43 patients (37%), while it infiltrated the submucosa in 73 others (63%). At the time of surgery, 9.5% of patients were found to have lymph node metastasis, always concomitant with submucosal invasion. There was 1 postoperative death (0.8%); 16 patients (13.7%) died of tumor recurrence, and 20 (17.2%) died of unrelated causes. Analysis of recurrence showed an intestinal histotype in 13 patients (81.2%), submucosal infiltration in 14 patients (87.5%), a Pen-A growth pattern in 8 patients (50%), and lymph node involvement in 3 patients (18.7%). The Cox proportional hazard model indicated that age and depth of wall invasion were statistically significant. The best predictor of survival appears to be the depth of invasion within the gastric wall. The claim by several investigators that prognosis for EGC is also associated with the presence of lymph node involvement is not supported by the present study. The postoperative 5-year survival rate in node-negative patients was 88.8% compared to 81.8% in node-positive patients (p = 0.296).     

Is Routine Recurrence Score Testing in Patients Older than 70 Years of Age Warranted? An Evaluation of the National Cancer Database After TAILORx

Annals of Surgical Oncology - Recurrence score (RS) testing in early-stage, ER-positive breast cancer is used to predict the benefit of adjuvant chemotherapy for disease recurrence and overall...     

Healed Cuff Repairs Impart Normal Shoulder Scores in Those 65 Years of Age and Older

Background  

It is unclear whether repaired rotator cuffs heal in older patients and whether the function in those shoulders compares with those of similarly aged patients with untreated tears.     

Results and Complications after Swedish Adjustable Gastric Banding—10 Years Experience

Background  

Bariatric surgery is currently the only effective treatment for morbid obesity. The main advantage of laparoscopic adjustable gastric banding is that this operation is minimally invasive to the stomach and adjustable to the patient’s needs. Few long-term studies on Swedish adjustable gastric banding (SAGB) have been published. We here report our 10-year experience with 785 SAGB procedures.     

High Complication Rate after Swedish Adjustable Gastric Banding in Younger Patients ≤25 Years

Background  Swedish adjustable gastric banding (SAGB) is an effective treatment for morbid obesity. The main advantage of this procedure is that this operation is minimally invasive to the stomach and totally reversible and adjustable to the patient’s needs. The aim of this observational study is to present our experience with patients ≤25 years old. Methods  Between January 1996 and January 2006, 107 patients (85 women, 22 men) of 785 consecutive patients who underwent SAGB during the study period were aged ≤25 years (13.6%). All data (demographic and morphologic data, operative data, and follow-up data) were prospectively collected in a computerized data bank. The postoperative follow-up program was performed most of the time by residents, and 17 different surgeons performed the operation. Results  The mean total weight loss was 27 kg after 1 year, reaching a total of 40 kg after 8 years. The mean EWL was 65.5% after 8 years, and the BMI decreased from 43.3 to 28.2 kg/m². In the 107 patients, there were 50 patients with 72 complications (46.7%) and 57 patients with no complication (53.3%). The most common complications were esophagitis (25.2%), pouch dilation (16.8%), port problems (6.5%), esophageal dilation (5.6%) and band leakage (4.7%). Overall, 31 patients (29%) needed a reoperation. There was no mortality. Conclusion  SAGB operation and the follow-up should only be performed by a small team of bariatric surgeons. Because of the high complication and reoperation rate, a gastric-band-specific patient selection will be necessary. On the basis of 8 years follow-up, SAGB is an effective bariatric procedure for achieving weight loss.