European Journal of Surgical Oncology
Volume 36 , Pages S18-S22 , September 2010

Should specialized oncogeriatric surgeons operate older unfit cancer patients?

  • B.L. van Leeuwen

      Affiliations

    • Department of Surgery, University Medical Center Groningen, The Netherlands
  • ,
  • S.R. Kristjansson

      Affiliations

    • Department of Geriatric Medicine, University of Oslo, Oslo University Hospital, Norway
  • ,
  • R.A. Audisio

      Affiliations

    • Department of Surgery, St Helens Teaching Hospital, University of Liverpool, Marshalls Cross Road, St Helens WA9 3DA, United Kingdom
    • Corresponding Author InformationCorresponding author. Tel.: +44 (0) 151 430 1079.

,Accepted 7 June 2010.

References 

  1. DePinho RA. The age of cancer. Nature. 2000;408:248–254
  2. Kirkwood TB. A systematic look at an old problem. Nature. 2008;451:644–647
  3. Janssen-Heijnen MLG, Houterman S, Lemmens VEPP, Louwman MW, Maas HA, Coebergh JW. Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit Rev Oncol Hematol. 2005;55:231–240
  4. Endreseth BH, Romundstad P, Myrvold HE, Wibe A. Norwegian Rectal Cancer Group. Rectal cancer treatment of the elderly. Colorectal Dis. 2006;8:471–479
  5. Peake MD, Thompson S, Lowe D, Pearson MG. Participating Centres. Ageism in the management of lung cancer. Age Ageing. 2003;32:171–177
  6. PACE participantsAudisio RA, Pope D, et al. Shall we operate? preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol. 2008;65:156–163
  7. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–877
  8. Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–429
  9. Leung JM, Dzankic S. Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc. 2001;49:1080–1085
  10. Hutchins LF, Unger JM, Crowley JJ, Coltman CA, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–2067
  11. Adunsky A, Lusky A, Arad M, Heruti RJ. A comparative study of rehabilitation outcomes of elderly hip fracture patients: the advantage of a comprehensive orthogeriatric approach. J Gerontol Ser A Biol Sci Med Sci. 2003;58:542–547
  12. Saltvedt I, Mo ES, Fayers P, Kaasa S, Sletvold O. Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. J Am Geriatr Soc. 2002;50:792–798
  13. Adunsky A, Arad M, Levi R, Blankstein A, Zeilig G, Mizrachi E. Five-year experience with the ‘Sheba’ model of comprehensive orthogeriatric care for elderly hip fracture patients. Disabil Rehabil. 2005;27:1123–1127
  14. Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285:2750–2756
  15. Welch HG, Albertsen PC, Nease RF, Bubolz TA, Wasson JH. Estimating treatment benefits for the elderly: the effect of competing risks. Ann Intern Med. 1996;124:577–584
  16. Hamel MB, Lynn J, Teno JM, et al. Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT. J Am Geriatr Soc. 2000;48:S176–S182
  17. Ajaj A, Singh MP, Abdulla AJ. Should elderly patients be told they have cancer? questionnaire survey of older people. BMJ. 2001;323:1160
  18. Kristjansson SR, Nesbakken A, Jordhoy MS, Skovlund E, Audisio RA, Johannessen HO, Bakka A, Wyller TB. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol, submitted for publication.
  19. Sjo O, Larsen S, Lunde O, Nesbakken A. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis. 2009;11:733–739
  20. Pope D, Ramesh H, Gennari R, et al. Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol. 2006;15:189–197
  21. Martin FC, Brighton P. Frailty: different tools for different purposes?. Age Ageing. 2008;37:129–131
  22. Inouye SK, Bogardus ST, Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–676
  23. Al Refaie WB, Parsons HM, Henderson WG, et al. Major cancer surgery in the elderly: results from the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg. 2010;251:311–318
  24. Massarweh NN, Legner VJ, Symons RG, McCormick WC, Flum DR. Impact of advancing age on abdominal surgical outcomes. Arch Surg. 2009;144:1108–1114
  25. Gardner GJ. Ovarian cancer cytoreductive surgery in the elderly. Curr Treat Options Oncol. 2009;10:171–179
  26. Berry MF, Hanna J, Tong BC, et al. Risk factors for morbidity after lobectomy for lung cancer in elderly patients. Ann Thorac Surg. 2009;88:1093–1099
  27. Lawrence VA, Hazuda HP, Cornell JE, et al. Functional independence after major abdominal surgery in the elderly. J Am Coll Surg. 2004;199:762–772
  28. Culley DJ, Xie Z, Crosby G. General anesthetic-induced neurotoxicity: an emerging problem for the young and old?. Curr Opin Anaesthesiol. 2007;20:408–413
  29. Rasmussen LS. Postoperative cognitive dysfunction: incidence and prevention. Best Pract Res Clin Anaesthesiol. 2006;20:315–330
  30. Stroobant N, Van Nooten G, DeBacquer D, Van Belleghem Y, Vingerhoets G. Neuropsychological functioning 3–5 years after coronary artery bypass grafting: does the pump make a difference?. Eur J Cardio Thor Surg. 2008;396–401:
  31. van den Kommer TN, Dik MG, Comijs HC, Jonker C, Deeg DJH. Homocysteine and inflammation: predictors of cognitive decline in older persons?. Neurobiol Aging. 2008;
  32. Exel E, Craen AJM, Remarque EJ, Gussekloo J, et al. Interaction of atherosclerosis and inflammation in elderly subjects with poor cognitive function. Neurology. 2003;61:1695–1701
  33. Hu Z, Ou Y, Duan K, Jiang X. Inflammation: a bridge between postoperative cognitive dysfunction and Alzheimer’s disease. Med Hypotheses. doi:10.1016/jmehy.2009.10.040.
  34. Ansaloni L, Catena F, Chattat R, et al. Risk factors and incidence of postoperative delirium in elderly patients after elective and emergency surgery. Br J Surg. 2010;97:273–280
  35. Benoit AG, Campbell BI, Tanner JR, et al. Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients. J Vasc Surg. 2005;42:884–890
  36. Marcantonio ER, Goldman L, Orav EJ, Cook EF, Lee TH. The association of intraoperative factors with the development of postoperative delirium. Am J Med. 1998;105:380–384
  37. Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA. 1990;263:1097–1101
  38. Beliveau MM, Multach M. Perioperative care for the elderly patient. Med Clin North Am. 2003;87:273–289
  39. Rutten HJ, den Dulk M, Lemmens VE, van de Velde CJ, Marijnen CA. Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol. 2008;9:494–501
  40. Legner VJ, Massarweh NN, Symons RG, McCormick WC, Flum DR. The significance of discharge to skilled care after abdominopelvic surgery in older adults. Ann Surg. 2009;249:250–255
  41. Owusu C, Lash TL, Silliman RA. Effect of undertreatment on the disparity in age-related breast cancer-specific survival among older women. Breast Cancer Res Treat. 2007;102:227–236
  42. Bouchardy C, Rapiti E, Fioretta G, et al. Undertreatment strongly decreases prognosis of breast cancer in elderly women. Clin Oncol. 2003;21:3580–3587
  43. Habr-Gama A, Perez RO. Non-operative management of rectal cancer after neoadjuvant chemoradiation. Br J Surg. 2009;96:125–127
  44. Volpe A. The role of surveillance in the management of small renal masses. ScientificWorldJournal. 2007;7:860–868
  45. Baatrup G, Breum B, Qvist N, et al. Transanal endoscopic microsurgery in 143 consecutive patients with rectal adenocarcinoma: results from a Danish multicenter study. Colorectal Dis. 2009;11:270–275
  46. Tei M, Ikeda M, Haraguchi N, et al. Postoperative complications in elderly patients with colorectal cancer: comparison of open and laparoscopic surgical procedures. Surg Laparosc Endosc Percutan Tech. 2009;19:488–492
  47. Wisnivesky JP, Henschke CL, Swanson S, et al. Limited resection for the treatment of patients with stage IA lung cancer. Ann Surg. 2010;251:550–554
  48. Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99:2051–2057
  49. Webb TP, Duthie E. Geriatrics for surgeons: infusing life into an aging subject. J Surg Educ. 2008;65:91–94
  50. Cicerchia M, Ceci M, Locatelli C, Gianni W, and Repetto L. Geriatric syndromes in peri-operative elderly cancer patients. Surg Oncol, submitted for publication.

PII: S0748-7983(10)00194-0

doi: 10.1016/j.ejso.2010.06.018

European Journal of Surgical Oncology
Volume 36 , Pages S18-S22 , September 2010