Outcomes in Octogenarians Undergoing High-Risk Cancer Operation: A National Study

Department of Surgery, University of Michigan, Ann Arbor, Michigan, United States
Journal of the American College of Surgeons (Impact Factor: 4.45). 12/2007; 205(6):729-34. DOI: 10.1016/j.jamcollsurg.2007.06.307
Source: PubMed

ABSTRACT Current information about outcomes in octogenarians undergoing cancer operations is limited largely to case series from selected centers. Population-based data can provide more realistic estimates of the risks and benefits of operations in this group.
We performed a retrospective cohort study of patients undergoing major resections for lung, esophageal, and pancreas cancer. Using the Nationwide Inpatient Sample (1994 to 2003), we examined operative mortality and discharge disposition in octogenarians (aged 80+ years), relative to younger patients (aged 65 to 69 years) (n = 272,662). We then used the Surveillance and End Results-Medicare-linked database (1992 to 2001) to measure late survival in the elderly (n = 14,088).
Operative mortality among octogenarians was substantially higher than that of younger patients (aged 65 to 69 years) for all three cancers (esophagectomy, 19.9% versus 8.8%, p < 0.0001; pancreatectomy, 15.5% versus 6.7%, p < 0.0001; lung resection, 6.9% versus 3.7%, p < 0.0001). A large proportion of octogenarians were transferred to extended care facilities after operation, ranging from 24% after lung resection to 44% after esophagectomy. Five-year survival in octogenarians was low for all three cancers: 11% after pancreatectomy, 18% after esophagectomy and 31% after lung cancer resection. Survival among octogenarians with two or more comorbidities was worse than those with fewer comorbid diagnoses--10% versus 14% for pancreatectomy, 15% versus 23% for esophagectomy, and 27% versus 37% for lung resection.
Population-based outcomes after high-risk cancer operation in octogenarians are considerably worse than typically reported in case series and published survival statistics. Such information might better inform clinical decision making in this high-risk group.

  • Source
    • "There is a difference between the mortality rate (mean 15.0%, range 4.7—15.5%) reported by cohort studies [10] [11] [20] and that reported by institutional reports (mean 3.9% range 0—13%) [8,9,12—19,21] and our own series (0%). The difference was ascribed mainly to a reporting bias [13], but, as reported by Riall [2], the mortality rate following surgery in octogenarians, is nearly twice as high at low-volume facilities compared to highvolume facilities. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic and perampullary neoplasms in patients aged 80 or older trouble the surgeons because of the risk of surgical treatment. We have reviewed our experience and literature's reports of pancreaticoduodenectomy in octogenarians, evaluating early results and long-term survival in pancreatic cancer group. Three hundred eighty-five patients who underwent pancreaticoduodenectomy for neoplasms from 1998 to 2011 were included in the study, and were divided in two groups: group 1, patients younger than 80years of age, and group 2, patients 80years of age and older. Operative morbidity, mortality, disease-free and long-term survival were analysed. English literature was systematically searched for pancreatic resection's outcome in octogenarians. There were 385 pancreaticoduodenectomies: 362 patients were in group 1 and 23 patients in group 2. There was no significant difference regarding gender, and pathologic findings between the two groups. Complications' rate (40 vs. 43%), mortality rate (4% vs. 0%), and overall median survival for pancreatic cancer patients were not statistically different in the two groups (median 21 vs. 19months). Literature's review showed 14 reports of pancreatic resection in octogenarians. Most of the studies (particularly in centres with high-volume pancreatic surgery) showed that outcome after pancreatectomy was not different in octogenarians or in younger patients. Pancreaticoduodenectomy is an acceptable option for elderly patients. Age alone should not be considered a contraindication to major pancreatic resection, but a careful preoperative evaluation and an accurate postoperative management are mandatory. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    Journal of Visceral Surgery 06/2015; DOI:10.1016/j.jviscsurg.2015.06.004 · 1.32 Impact Factor
  • Source
    • "c o m / l o c a t e / c l o n 71% of peri-operative deaths, but only about 25% of the operations carried out. Moreover, a population-based study from Michigan, USA reported that age was a significant prognostic indicator in patients undergoing surgery for lung, oesophageal and pancreatic cancer, with operative mortality of up to 19.9% in patients over the age of 80 years and a 5-year survival of 18% [10]. Therefore, the aim of the present study was to compare the outcomes of patients undergoing surgery with those of patients undergoing CRT, related to age, to determine if there was an age limit above which the risks of surgery outweighed any potential survival benefit. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To compare the outcomes of stage-directed surgical therapy and chemoradiotherapy (CRT) for oesophageal cancer and to determine if a significant age-treatment interaction exists to guide therapy. Five hundred and eight consecutive patients with oesophageal cancer suitable for radical treatment based on radiological stage and performance status were studied (275 surgery; 93 surgery alone, 131 neoadjuvant chemotherapy, 51 neoadjuvant CRT and 233 definitive CRT). The primary measure of outcome was survival. Thirty-day mortality rates and 2-year survival after surgery and CRT in patients<70 years were 2.4 and 57.5%, respectively, compared with 0 (P=0.207) and 47.3% (P=0.011), respectively. Thirty-day mortality rates and 2-year survival after surgery and CRT in patients>or=70 years were 7.0 and 45.1%, respectively, compared with 0 (P=0.029) and 46.3% (P=0.992), respectively. Multivariate analysis including only surgical patients in the model revealed three factors to be independently and significantly associated with survival; endoscopic ultrasound (EUS) T stage (P=0.033), EUS lymph node metastasis count (>or=2 versus 0: hazard ratio 1.67, 95% confidence interval 1.06-2.92, P=0.026), and age>or=70 years (hazard ratio 1.51, 95% confidence interval 1.05-2.16, P=0.025). Overall survival for patients treated with surgery was strongly age dependent around the age of 70 years, and patients>or=70 years with oesophageal cancer should be aware that outcomes after CRT are similar to those after surgery.
    Clinical Oncology 09/2010; 22(7):578-85. DOI:10.1016/j.clon.2010.05.023 · 2.83 Impact Factor
  • Source
    • "We here reviewed retrospectively the clinical data from the consecutive patients with lung cancer diagnosed at our two tertiary hospitals to assess the incidence and outcome of lung cancer in the very elderly. According to the same analyses as previous studies [6] [10], this study characterized lung cancer presentation and outcome in the very elderly patient population and compared it with that of septuagenarians and with the younger patient population. It is noteworthy that the ≥80 age group account for 7.5% of all lung cancers. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study is to examine clinical and pathological features, treatment modality approaches in the elderly, especially in patients aged 80 years and older. From the databases at two educational hospitals during the period from January 1978 and December 2007, medical records of lung cancer patients were retrospectively reviewed. The patient population was divided into three age groups: less than 70 years (the <70 age group), 70-79 years (the 70-79 age group), and 80 years or older (the > or =80 age group). Time trends were also studied in two-time intervals: first study period up to 1997, which represents past practice standards, the second study period up to 2007, which represents contemporary practice. Patients aged 80 years and older comprised 7.5% of 2775 consecutive patients with lung cancer, and there was a rapid increase in the proportion of patients aged 80 years or older from the earlier to the later time period. The > or =80 age group had higher proportion of poor performance status (PS) and comorbid disease than the <70 age group and the 70-79 age group. Unchanged proportion of patients with poor PS and advanced disease at presentation were observed in the > or =80 age group. The > or =80 age group was less likely to be subjected to surgery or chemotherapy, and had inferior outcomes when compared with the 70-79 age group and the <70 age group. Survival improvement was not observed in the > or =80 age group. Multivariate analysis showed good PS, early clinical stage and surgery were favorable prognostic factors in the > or =80 age group. In order to improve the outcome, detection of early stage lung cancer in patients with good PS and thorough pretreatment evaluation for appropriate treatment are indeed essential even for the > or =80 age group of patients.
    Lung cancer (Amsterdam, Netherlands) 07/2009; 65(1):112-8. DOI:10.1016/j.lungcan.2008.10.020 · 3.74 Impact Factor
Show more