Differences in clinicopathological characteristics of colorectal cancer between younger and elderly patients: an analysis of 322 patients from a single institution

Background

The prognosis of patients with colorectal cancer (CRC) of different onset ages is controversial.

Methods

Data were obtained from a prospective database at Taipei Veterans General Hospital. There were 2,738 newly diagnosed patients with CRC from 2001 to 2006. Two extreme age groups, younger (≤40 years) and elderly (≥80 years), were analyzed to compare clinicopathologic characteristics and prognosis after exclusion of specific cancer syndrome.

Results

A total of 322 patients were enrolled in this prospective study. The younger group consisted of 69 patients with mean age of 33.5 years, and the elderly group consisted of 253 patients with mean age of 83.4 years. Younger patients had a higher incidence of mucinous cell type (14.5% vs 6.3%, P = .05), poorly differentiated adenocarcinoma (26.1% vs 6.3%, P < .001), more advanced disease (82.6% vs 41.9%, P < .001), poorer disease-free survival (67.2% vs 79.3%, P = .048), and cancer-specific survival (44.1% vs 73.1%, P < .001) than elderly patients.

Conclusions

In patients with CRC of younger onset, without relevant predisposing risk factors, younger patients have more advanced stages of disease, more aggressive histopathologic characteristics, and poorer prognoses compared with older patients.     

Outcomes of Surgery for Mid and Distal Rectal Cancer in the Elderly

Background This study aimed to evaluate the surgical strategies, operative results, and oncological outcomes of elderly patients who underwent curative resection for mid and distal rectal cancer. Comparison was made with patients of younger age. Study Design Of the 612 patients who underwent curative resection for rectal cancer, 133 were older than 75 years of age. Comparisons were made between the young and elderly patients in the aspects of operative strategies, operative results, and long-term outcomes. Results Resection resulting in a permanent end colostomy was performed in 96 patients (15.7%), and there was no difference between young and elderly patients. There was a female predominance in the elderly group. Elderly patients also had a higher incidence of comorbid medical diseases, especially cardiovascular and neurological diseases. The operative time, blood loss, and incidence of intraoperative complications did not differ in the two groups. However, significantly fewer elderly patients underwent adjuvant radiation and/or chemotherapy. The overall 30-day mortality was 1.14%. There was no difference between the elderly patients and younger patients in hospital mortality (P = 0.178). The complication rates of the elderly and young patients were 36.8% and 30.1%, respectively (P = 0.141). Comparison between the individual complications in the elderly and young patients revealed significantly more cardiovascular complications in the elderly patients. With the median follow up of the surviving patients of 45.1 months, the overall 5-year survival of the elderly and younger groups was 47.7% and 70.1%, respectively (P < 0.001). The 5-year cancer-specific survival was 75.4% and 67.5% in the young and elderly patients, respectively (P = 0.061). Conclusions Curative resection for mid and distal rectal cancer for the elderly can be performed safely with the same strategies of sphincter preservation used for younger patients. The postoperative complications and the 5-year cancer-specific survival rates were similar to those of younger patients.     

Postoperative suppression of inflammatory cytokines after distal gastrectomy in elderly patients

Purpose  Surgical procedures are being performed on elderly people with increasing frequency, but accordingly, postoperative complications and mortality rates are higher than for younger patients. We conducted this study to establish if cytokine responses after distal gastrectomy in elderly patients differ from those in younger patients. Methods  Twenty-one patients undergoing distal gastrectomy were divided into two groups based on age: the elderly group consisted of 10 patients aged ≥75 years, and the younger group consisted of 11 patients aged <65 years. Blood samples were collected from the patients preoperatively, and then on postoperative days (PODs) 1, 3, and 7, for analysis of interleukin (IL)-6, IL-8, IL-10, soluble tumor necrosis factor receptors (sTNF-R), and IL-1 receptor antagonist (IL-1ra); and also to measure TNF-α and IL-1β after incubation with Escherichia coli lipopolysaccharide. Results  The IL-6 concentration and TNF-α on POD 1 were both significantly lower in the elderly group than in the younger group (P = 0.0058 and P = 0.022, respectively). Conclusion  Cytokine profiles after distal gastrectomy in elderly patients differ from those in younger patients, with lower pro-inflammatory and inflammatory cytokine responses evident in the elderly.     

Ileal pouch–anal anastomosis in elderly patients: is there a difference in morbidity compared with younger patients?

Aim The aim of this study was to review the recent results of ileal pouch–anal anastomosis (IPAA) in elderly patients compared with younger patients. Method Retrospective evaluation was carried out based on a prospective Institutional Review Board approved database of patients who underwent IPAA from 2001 to 2008. Patients aged ≥65 years were matched with a group of patients aged <65 years by gender, date of procedure, diagnosis and type of procedure performed. Preoperative and intra‐operative data and early postoperative complications were obtained. Results Thirty‐three patients (22 women), 32 with mucosal ulcerative colitis, were included in each group. The elderly group had a mean age of 68.7 years, body mass index of 27 kg/m², duration of disease of 17.4 years, high American Society of Anesthesiologists (ASA) score and high incidence of comorbid conditions (87.9% had one or more). Dysplasia and carcinoma were the indication for the surgery in more than 50% of patients, followed by refractory disease (24.4%). The matched younger group had a mean age of 36.9 years, body mass index of 25.4 kg/m², shorter duration of disease (8.1 years; P = 0.001), lower ASA score (P = 0.0001) and lower comorbidity (42.4%; P = 0.0002). Operative data were similar for both groups. The elderly group had a higher rate of rehospitalization for dehydration (P = 0.02). Other medical complications (30 vs 27%) and surgical postoperative complications (33 vs 24%) were similar for both groups. The long‐term function and complications were comparable for the groups. Conclusion Elderly patients who underwent IPAA had more comorbid conditions than younger patients. Except for rehospitalization for dehydration, medical and surgical postoperative complications were not different in the two groups.     

Impact of Age,Sex and Body Mass Index on Outcomes at Four Years after Gastric Banding

Background: Adjustable gastric banding for weight reduction in severely obese persons allows reversible individualized restriction during postoperative follow-up. It is unknown whether preoperative age, sex and BMI might modulate treatment outcome. Methods: 404 severely obese patients (79% women; age 42±0.5 years [mean±SEM]; BMI 42.1±0.2 kg/m²) completed 4-year follow-up after banding. Weight loss, complications, and Bariatric Analysis and Reporting Outcome System (BAROS) scores were recorded prospectively. Results: 4 years after banding, younger (<50 years) women lost more weight than older (≥50 years) men (28.2±0.7 % vs 19.4±1.6 %; P=0.001); older women and younger men lost similar weight. Patients with preoperative BMI >50 lost more weight than patients with BMI <35 (30.5±2.3 % vs 22.8±2.6 %; P=0.03). 22.3% of patients (n=90) had band system-related complications. Compared to women, men had more band leaks (7.0% vs 1.9%; P=0.007), and older men had more band slippages than younger men (8.4% vs 0.0%; P=0.035). Patients with preoperative BMI >50 were less likely than patients with BMI 35–40 or 40–50 to experience gastric complications (10.6%, 18.8%, 23.0%, respectively), but more likely to experience port/tube complications (15.8%, 2.4%, 7.9%, respectively; P<0.055). BAROS scores were different between men and women (P=0.05), and between younger and older people (P =0.001). Women and younger people were more likely than men and older people to score "very good" (P=0.03, P=0.001, respectively). Conclusions: Adjustable gastric banding is an effective intermediate-term treatment for severe obesity. Preoperative age, sex, and BMI are important modulators of outcome and should be considered during preoperative evaluation.     

Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study

Chronic subdural haematoma (CSDH) is a typical disease in elderly patients and encountered frequently in neurosurgical practice. With an increasing number of elderly people in the general population, there is a need to investigate risk factors (age, falls, anticoagulant or antithrombotic therapy) which could be pertinent to the development of this disease. We reviewed 354 patients undergoing surgery for CSDH over a period of 7 years (1996–2002), the occurrence being equally distributed over these years. CSDH occurred more often in elderly (65 years) than in younger people (69 vs 31%), and in men than in women (64 vs 36%). Falls were reported in 77% of patients. There was a trend towards a higher risk of falls in the elderly. Antithrombotic or anticoagulant therapy was present in 41% of patients, 32% of them having had falls. Overall postoperative mortality was 0% and overall recurrence rate 13.6%. CSDH in the elderly population, especially in men, is frequently associated with falls and anticoagulation or antithrombotic therapy. The indication for these medications, especially in elderly patients at risk for falls, should be carefully evaluated and controlled.These data were presented at the 8th EMN Congress, 21–24 May 2003 in Graz, Austria     

Gastric resection in the aged (≥ 80 years) with gastric carcinoma: a multivariate analysis of prognostic factors

Background : The incidence of gastric neoplasm is increasing in the elderly population. Therefore, a rational method of treatment for gastric cancer in the elderly should be constituted to improve the survival. The purpose of the present study was to clarify whether the patient’s age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly. Methods : Curative resection of gastric cancer was carried out on 601 patients who were 40 years or older. They were divided into the following two groups: younger patients (between 40 and 79 years old) and elderly patients (80 years or older). The clinicopathologic features of these patients were reviewed retrospectively and multivariate analysis was carried out. Results : The distinguishing features of gastric cancer in the elderly patients were intestinal and mixed types of cancer, distal third stomach dominancy in the tumour location, advanced stage of disease, and a low rate of extensive lymph node dissection (D3 or more). Regarding the recurrence site, the liver was the dominant site in the elderly group (25.3% in the younger group vs 54.5% in the elderly group). The 10‐year disease‐free survival rate of the elderly group was 53.2%, which was significantly worse than that (79.9%) of the younger patients (P = 0.0004). In multivariate analysis, an age of ≥ 80 years is an independent prognostic factor, as well as stage, depth of tumour invasion, lymph node metastasis, scirrhous carcinoma, and blood transfusion. Conclusions : Results indicate that gastric cancer in elderly patients has a poorer prognosis than that in younger patients.     

Safety and efficacy of isolated limb perfusion in elderly melanoma patients

Background Older patients are assumed to have a higher risk of complications from isolated limb perfusion (ILP). A study was performed evaluating the safety and efficacy of ILP in patients older than 75 years with advanced melanoma of the limbs. Methods A total of 218 therapeutic ILPs with melphalan with or without tumor necrosis factor α were performed in 202 patients with advanced measurable melanoma and were analyzed retrospectively. Fifty-three patients (28%) were 75 years or older. Results Complete response rates were 56% for those older than 75 years and 58% for the younger group (P=.79). Locoregional relapse occurred in 56% of the older group versus 51% in the younger group (P=.61). Limb toxicity, systemic toxicity, local complications, and long-term morbidity were similar in both age groups. Perioperative mortality was low, with one procedure-related death in the older group. Older patients stayed in the hospital for a median of 23 days (younger patients, 19 days;P<.01). Conclusions ILP results in similar response rates in the elderly with recurrent melanoma, without increased toxicity, complications, or long-term morbidity compared with younger patients. Older age in itself is not a contraindication for ILP.     

Perioperative risk factors affecting hospital stay and hospital costs in open heart surgery for patients≥65 years old

Objective: Demographic changes, associated with increased demands for open heart surgery in the elderly, place increased burden on financial resources. To evaluate perioperative risk factors affecting incidence of hospital events and estimation of hospital charges, 2577 patients≥65 years (range 65–91), operated on from January 1991 to December 1994, were compared with a concurrent cohort of 2642 younger patients. Methods: Statistical analysis, by surgical procedure, focused on hospital mortality, key postoperative complications affecting length of hospital stay and hospital charges. Results: Overall hospital mortality was 4.7%, 3.5% in younger patients versus 6.1% in the older group (P0.01). Mortality was significantly lower in patients less than 65 years undergoing coronary artery bypass grafting (3% versus 5%, P<0.01) and valve replacement (4% versus 9%, P=0.01). Significant risk factors for hospital death in the elderly: diabetes (P<0.01), hypertension (P<0.01), myocardial infarction (P<0.01) and congestive heart failure (P<0.01). Significant postoperative events, more common in older patients, included prolonged ventilation (P0.01), congestive heart failure (P0.01), infection (P0.01), cerebrovascular accident (P<0.01), and intra aortic balloon pump (P<0.01). Incremental risk factors for morbidity in the elderly were: higher New York Heart Association class, congestive heart failure, emergent operation, and female gender. Mean length of hospital stay for the <65 group was 15.3 versus >19.5 days for the ≥65 group (P0.01). Length of stay over 18 days positively correlated with increased morbidity in both age groups. For patients ≥65 years of age, the average hospital charge for open heart surgery was 172% higher for patients with a length of stay greater than 18 days compared with 165% for patients less than 65 years of age. Conclusions: Higher operative mortality and longer length of stay in elderly patients, resulting in increased health care costs, was associated with more co-morbidities. These results suggest interventions designed to reduce congestive heart failure and other co-morbidities may improve patient's recovery and reduce costs.     

Hepatectomy in Elderly Patients: Does Age Matter?

Background

With the increase in average life expectancy in recent decades, the proportion of elderly patients requiring liver surgery is rising. The aim of the meta-analysis reported here was to evaluate the safety and efficacy of hepatectomy in elderly patients.

Methods

An extensive electronic search was performed for relevant articles that compare the outcomes of hepatectomy in patients ≥70 years of age with those in younger patients prior to October 2012. Analysis of pooled data was performed with RevMan 5.0.

Results

Twenty-eight observational studies involving 15,480 patients were included in the analysis. Compared with the younger patients, elderly patients experienced more complications (31.8 vs 28.7 %; P = 0.002), mainly as a result of increased cardiac complications (7.5 vs 1.9 %; P < 0.001) and delirium (11.7 vs 4.5 %; P < 0.001). Postoperative major surgical complications (12.6 vs 11.3 %; P = 0.55) and mortality (3.6 vs 3.3 %; P = 0.68) were comparable between elderly and younger patients. For patients with malignancies, both the 5-year disease-free survival (26.5 vs 26.3 %; P = 0.60) and overall survival (39.5 vs 40.7 %; P = 0.29) did not differ significantly between the two groups.

Conclusions

Postoperative major surgical complications, mortality, and long-term results in elderly patients seem to be comparable with those in younger patients, suggesting that age alone should not be considered a contraindication for hepatectomy.     

Renal transplant recipients over aged 60 have diminished immune activity and a low risk of rejection

Strict consideration of the renal transplant candidates chronologic age is generally supplanted by more subjective reflection on his (her) physiologic state. In the US, patients over 64 years old represented 9.0% of renal transplant recipients in the year 2000, yet little prior experience is available with which to guide the management of geriatric patients. Two hundred and forty six consecutive recipients of primary kidney transplants at the Yale–New Haven Organ Transplant Center between 1990 and 1995 were included in an outcome analysis. Age at transplantation ranged from 2 to 68 years; the study group consisted of the 16 (6.5%) over age 60. The immunosuppressive protocol was uniform for all patients. There was a disproportionately high use of cadaveric organs by older patients; only 1/16 (6.3%) received a living donor kidney. The overall rate of rejection within the first 90 days was 6.7% of cadaveric recipients over 60 versus 37.6% of younger recipients, P=0.001. Actual patient survival rates at 6 years were 100% of patients younger than 11 years versus 69% (11/16) of those older than 60 years. Death censored 5 year graft survival was 100% in older patients versus 85% among the younger patients. The older and younger patients received quantitatively equivalent immunosuppression, but acute rejection was uncommon in the former (6%) versus the younger cohort (34%). It seems logical to consider whether older renal transplant recipients may benefit from a less aggressive immunosuppression strategy.     

Should pancreaticoduodenectomy be performed in octogenarians?

As the population in the United States ages, an increasing number of elderly patients may be considered for pancreaticoduodenal resection. This high-volume, single-institution experience examines the morbidity, mortality, and long-term survival of 727 patients undergoing pancreaticoduodenectomy between December 1986 and June 1996. Outcomes of patients 80 years of age and older (n = 46) were compared to those of patients younger than 80 years. In these older patients, pancreaticoduodenectomy was performed for pancreatic adenocarcinoma (n = 25; 54%), ampullary adenocarcinoma (n = 9; 20%), distal bile duct adenocarcinoma (n = 5; 1 l%), duodenal adenocarcinoma (n = 2; 4%), cystadenocarcinoma (n = 2; 4%), cystadenoma (n = 1; 2%), and chronic pancreatitis (n = 2; 4%). When compared to the 681 concurrent patients younger than 80 years who were undergoing pancreaticoduodenectomy, the two groups were statistically similar with respect to sex, race, intraoperative blood loss, and type of pancreaticoduodenectomy performed. Patients 80 years of age or older had a shorter median operative time (6.4 hours vs. 7.0 hours; P = 0.02) but a longer postoperative length of stay (median = 15 days vs. 13 days; P = 0.01) and a higher complication rate (57% vs. 41%; P = 0.05) when compared to their younger counterparts. Pancreaticoduodenectomy in the older group resulted in a 4.3% perioperative mortality rate compared to 1.6% in the younger group (P = NS). In the subset of patients undergoing pancreati-coduodenectomy for periampullary adenocarcinoma (n = 495), patients 80 years of age or older (n = 41) had a median survival of 32 months and a 5-year survival rate of 19%, compared to 20 months and 27%, respectively, in patients younger than 80 years (n = 4.54; P = 0.77). These data demonstrate that pancreaticoduodenectomy can be performed safely in selected patients 80 years of age or older, with morbidity and mortality rates approaching those observed in younger patients. Based on these data, age alone should not be a contraindication to pancreaticoduodenectomy. Presented at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 11–14, 1997 (poster presentation). An abstract of this work was published in Ga.rtmenteroiogy 112:A1475, 1997. Supported in part by a grant from the National Institutes of Health (ROl-CA56130).     

胆石性肠梗阻的诊断与治疗：附302例分析

目的：分析胆石性肠梗阻（BI）的临床特点和诊治现状。 方法：回顾1995年1月—2014年12月间中南大学湘雅医院收治的18例BI患者资料,并汇总近20年22篇中文文献中284例患者资料,分析并总结BI发病特点与诊治现状。 结果：302例BI患者中男86例（28.2%）,女216例（71.8%）;年龄36~89岁,平均63.4岁;术前确诊率为24.2%（73/302）;294例（97.4%）行小肠切开取石术,8例（2.6%）行肠切除肠吻合术;结石嵌塞于十二指肠27例（8.9%）,空肠71例（23.5%）,回肠末端201例（66.6%）,结肠3例（1.0%）;一期行胆囊切除术94例（31.1%）,胆管切开取石术4例（1.3%）;术后并发症发生率为27.2%（82/302）,术后病死率为0.7%（2/302）。 结论：BI多见于老年女性患者,常伴有较低的术前确诊率和较高的术后并发症率。

     

Long-term Outcomes and Prognostic Factors of Elderly Patients with Hepatocellular Carcinoma Undergoing Hepatectomy

Objective  The present study aimed to evaluate the long-term outcomes and prognostic factors of elderly patients with hepatocellular carcinoma (HCC) undergoing hepatectomy. Material and Methods  From January 1983 to December 2006, 2,283 patients with HCC received hepatectomy in Sun Yat-sen University Cancer Center. The clinicopathological data and treatment outcomes of 67 elderly HCC patients (elderly group, ≥70 years of age) and 268 patients (control group, <70 years of age) who were selected randomly from the 2216 younger patients were compared retrospectively. Results  The elderly HCC patients had lower hepatitis B surface antigen-positive rate (P < 0.001), lower rate of marked α-fetoprotein elevation (P = 0.004), higher infection rate of hepatitis C virus (P = 0.010), more preoperative comorbidities (P < 0.001), higher rate of tumor encapsulation (P = 0.040), and better overall survival rate (P = 0.017); whereas there were no significant differences between these two groups in other factors, including gender ratio, liver function, accompanying cirrhosis, pathological tumor–node–metastasis (pTNM) staging, satellite nodules, vascular invasion, tumor rupture, resection margin, intraoperative blood loss, incidence of postoperative complications, hospital mortality, and disease-free survival rate. Multivariate analysis showed that pTNM staging was an independent prognostic factor of long-term survival in elderly patients with HCC. Conclusion  HCC in the elderly was less HBV-associated, less advanced, and less aggressive. Hepatectomy for selected elderly patients with HCC possibly have a better curative effect compared with younger patients. For the elderly patients without preoperative comorbidities or with controlled comorbidities, hepatectomy is a safe and effective treatment. pTNM staging is the only independent predictor of postoperative overall survival in elderly HCC patients.     

Attitudes toward islet cell and tissue xenotransplantation among kidney and liver patients on the transplant waiting list

Introduction

Research into xenotransplantation is centered on the fields of organs, tissues, and cells. However, the use of animals in this therapy is creating social rejection among the general public as well as among patients on the transplant waiting list.

Objective

The objective of this study was to analyze the attitudes of patients on the waiting list toward a possible transplantation of cells or tissues of animal origin.

Materials and Methods

The study included patients on the kidney and liver transplant waiting lists from January 2003 until December 2005 (N = 373). Attitudes toward xenotransplantation were assessed using a psychosocial questionnaire about the donation of animal organs. The questionnaire was administered through a direct personal interview.

Results

With regard to the xenotransplantation of tissues and cells, 83% of kidney patients (n = 177) were in favor and 17% (n = 37) were not in favor of both options. Patients who were more in favor for tissues and also for cells were young respondents (P = .016; age P = .006) and those with a formal education (P = .002; education P = .001). Among liver patients, 85% (n = 134) were in favor and 15% (n = 24) were not in favor. Those who were more in favor for tissues included elderly patients (P = .028) and those with descendents (P = .001); for cells, those who were more in favor were those who were married (P = .011), were older (P = .009), and had children (P < .000). No significant differences were observed between the groups.

Conclusion

Patients on the solid organ transplant waiting lists showed favorable attitudes toward tissue and cell xenotransplantation.     

Perioperative and long-term outcomes after pancreaticoduodenectomy in elderly patients 80 years of age and older

Purpose

Although a pancreaticoduodenectomy (PD) has been recently regarded as a safe surgical procedure at high-volume centers, the efficacy of PD for patients 80 years of age and older is controversial. The aim of this study was to evaluate the perioperative and long-term outcomes following PD in patients 80 years of age and older.

Methods

Elderly patients 80 years of age and older who underwent PD between 2001 and 2009 were identified. The perioperative and long-term outcomes were compared with patients younger than 80 years of age.

Results

Of 561 total patients, 22 patients (3.9 %) were 80 years of age or older. Mortality occurred in one patient (4.5 %). Postoperative major complications (Clavien–Dindo classification ≥grade III) occurred in six patients (27.3 %) in this group, which was significantly higher than in patients younger than 80 years of age (P?=?0.008). The survival of the elderly patients undergoing PD for pancreatic cancer was significantly shorter than that for the same patient group with other diseases (median survival, 13 versus 82 months; P?=?0.014). Only one elderly patient with pancreatic cancer survived more than 3 years.

Conclusions

PD for pancreatic cancer in patients aged 80 and older should be carefully selected, because it is associated with a higher incidence of severe postoperative complications and a small change of long-term survival.     

ABDOMINAL SURGERY IN THE OLDER CROHN’S POPULATION

Background : The surgical literature perceives that the elderly cohort of Crohn’s patients may have increased risk with surgery. Methods : A retrospective review and prospective database analysis of all patients with histologically proven Crohn’s disease who had a laparotomy at a single Sydney teaching hospital were performed. The last laparotomy of each patient was included in the analysis for morbidity and mortality to assess whether an older cohort was at an increased risk. Results : A total of 156 patients had 298 laparotomies for histopathologically proven Crohn’s disease. The frequency distribution of age at last laparotomy was bimodal, and the statistically determined cut-off age between younger and older cohorts was 55 years. Thirty-three patients were older than 55 years. There was no difference in duration of symptoms before first diagnosis (older, 17 months vs younger, 25 months), previous number of Crohn’s operations (42.4 vs 39.8%), or duration of known Crohn’s disease. Isolated large bowel disease was more common in the elderly cohort (42.4 vs 18.7%, χ ² = 8.09, P < 0.01). Small bowel and ileocaecal resections were more common in the younger cohort (72.4 vs 51.6%, χ ² = 5.19, P < 0.025). There was one death in each cohort (overall mortality 1.3%) and anastomotic leak rates (defined as the number of leaks per number of patients with anastomoses), were 4.3% (older) vs 5.3% (younger) despite frank sepsis present in 21.2% of all subjects at the time of surgery. The older group had more cardiac (18.2 vs 0.8%, P < 0.001) and respiratory complications (18.2 vs 2.4%, P = 0.0003) and a longer mean but not median postoperative hospital admission. Conclusions : In conclusion, clinical features and presentation are similar in the older and younger Crohn’s patients having a laparotomy. However, in the older patient there is a greater likelihood of large bowel disease, ileocaecal resection is done less commonly, there is a higher risk of minor cardiopulmonary postoperative complications, but with similar mortality and anastomotic leak rates to the younger patient.     

Surgical treatment for multinodular goitres in geriatric patients

Background Although age is not a contraindication for thyroid surgery, few elderly patients undergo surgery due to the greater risk of morbidity. The aims of this study are to determine in patients aged >65 years: (1) whether the indications for surgery on multinodular goitre (MG) differ with respect to younger patients; (2) the surgical results; and (3) whether the postsurgery morbidity and mortality rates are higher.Patients and method Eighty-one patients aged over 65 years who were receiving surgery for MG were analysed; 40 49%) presented with associated co-morbidities. Sixty percent had thyroid symptoms, either compressive and/or toxic. All underwent programmed surgery following stabilisation and strict control of their co-morbidities. As a control group we used 510 MG patients receiving surgery and aged between 30 and 65 years.Results Compared with the control group the geriatric patients had a longer time of goitre evolution (P=0.032), greater presence of symptoms (P=0.001) and a higher percentage of intrathoracic component (P=0.001). Compressive symptoms were the major indication for surgery (P=0.001). Postoperative complications occurred in 40% of the patients, a higher rate than in the control group (28%; P=0.011), although a large percentage of those complications were transitory. Definitive complications included two recurrent laryngeal nerve injuries (2.5%). The preoperative symptoms remitted in all the patients, and only three were associated with a thyroid carcinoma, one of which was anaplastic.Conclusions MG operated on in elderly patients has a longer evolution and an intrathoracic component, and surgery is indicated restrictively. With close monitoring of the co-morbidities and a programmed operation the results with regard to morbidity and mortality are similar to those obtained at younger ages.     

Pancreatic resection for periampullary carcinoma in the elderly

The effect of pancreatic resection for periampullary carcinoma in the elderly was studied by comparing the pre-and perioperative factors affecting survival in 102 patients less than 70 years of age (group A) with those in 28 patients 70 years and older (group B). Concomitant cardiac and pulmonary diseases were significantly more frequent in group B (P < 0.05), but the difference in routine laboratory data was not significant. The overall operative mortality was 7% (7/102) in group A and 18% (5/28) in group B, while the actuarial 5-year survival rates were 31%o in group A and 23% in group B, these differences not being significant. A multivariate analysis using a logistic model showed that blood loss was the greatest risk factor for early postoperative death in the elderly patients, whereas anastomotic dehiscence and postoperative bleeding were significant factors in the younger patients. Thus, we conclude that age is not a contraindication to pancreaticoduodenectomy which offers the only hope for long-term survival in patients with periampullary carcinoma; however, meticulous dissection to minimize blood loss is especially important in elderly patients.     

Colorectal endoscopic submucosal dissection for elderly patients at least 80?years of age

Background

Endoscopic submucosal dissection (ESD) has been used recently for successful en bloc resection of even large lesions, although no consensus appears in medical literature concerning its application to elderly patients. This prospective cohort study aimed to evaluate the efficacy and safety of colorectal ESD for patients 80?years of age or older.

Methods

Colorectal ESD procedure findings were compared with clinical outcomes, including associated complications and mortalities, for two age groups totaling 196 consecutive patients with 202 colorectal lesions. Of the 196 patients, 31 patients (16%) were 80?years of age or older (group E), and 165 patients (84%) were younger than 80?years (group Y).

Results

The median ages were 82?years in group E and 68?years in group Y. The frequency of chronic concomitant diseases was significantly higher in group E (65%) than in group Y (27%) (p?=?0.003). No significant pressure decrease or need for oxygenation was observed in either group. In addition, groups E and Y did not differ significantly in terms of mean lesion sizes (40.9 vs. 39.7?mm) en bloc resection rates (84% vs. 93%), curative rates (78% vs. 84%), median procedure times (65 vs. 70?min), or associated complications (no perforation or delayed bleeding cases [0%] vs. 5 perforations [3%]) The median postprocedure hospitalization period was 3?days in both groups. Except for 10 cases requiring subsequent lymph node dissection surgery, follow-up colonoscopy examinations showed no recurrences or ESD-related mortalities in either group.

Conclusion

Colorectal ESD is a safe and effective treatment for elderly patients (age????80?years) despite a significantly higher frequency of chronic concomitant diseases than among younger patients.