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Upper abdominal cancer surgery in the very elderly
H R Alexander1, A D Turnbull, J Salamone
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
Journal of Surgical Oncology
|June 1, 1991
Summary
Elderly patients (80-90 years) undergoing major upper abdominal surgery had a 15% mortality rate. Major resections offered better survival than bypass procedures, with a formalized protocol for high-risk patients.
Area of Science:
- Geriatric Surgery
- Surgical Oncology
- Gastrointestinal Surgery
Background:
- Major upper abdominal operations in elderly patients (80-90 years) present unique challenges.
- Limited data exists on outcomes for this specific demographic undergoing complex gastrointestinal procedures.
Purpose of the Study:
- To evaluate the outcomes of major upper abdominal operations in octogenarian and nonagenarian patients.
- To assess mortality, morbidity, and survival rates associated with different surgical procedures in this age group.
Main Methods:
- Retrospective review of 59 major upper abdominal operations performed between 1981 and 1987 on 57 patients aged 80-90 years.
- Analysis of procedures including curative/palliative resections, bypass, and emergency operations for various gastrointestinal malignancies and benign conditions.
Main Results:
- Overall hospital mortality was 15%, with 9% for major resections and 67% for emergency procedures.
- Major complications occurred in 20% of elective procedures, commonly arrhythmias and wound infections.
- Median survival was 17.5 months after major resection, significantly longer than after bypass procedures.
Conclusions:
- Major upper abdominal surgery in elderly patients (80-90 years) can be undertaken with acceptable mortality, especially for major resections.
- A formalized protocol for pre-operative evaluation, intra-operative monitoring, and postoperative care is crucial for optimizing outcomes in high-risk elderly surgical patients.