[Multimorbid patients in endocrine surgery]

Area of Science:

• Endocrine surgery
• Geriatric medicine
• Oncology

Context:

• Increasing prevalence of endocrine surgery in elderly, frail, and multimorbid patients.
• These complex cases often present with unique risk factors and may require urgent intervention.
• The decision-making process for these patients necessitates a careful evaluation of surgical risks versus benefits.

Purpose:

• To evaluate the outcomes and indications for endocrine surgery in vulnerable patient populations.
• To provide guidance on managing parathyroid, thyroid, adrenal, and gastroenteropancreatic neuroendocrine tumor (GEP-NET) surgeries in frail individuals.
• To delineate when surgical intervention is most beneficial versus when alternative treatments or surveillance should be considered.

Summary:

• Parathyroid gland surgery consistently leads to significant patient improvement, regardless of the patient's risk profile.
• Thyroid gland surgery is generally beneficial and justifiable for frail patients, with exceptions for critical intubation and mediastinal interventions.
• For adrenal gland and GEP-NET surgeries, the extent of resection, disease characteristics, and tumor grade are crucial in determining the optimal treatment strategy for at-risk patients.

Impact:

• Informs clinical decision-making for endocrine surgery in high-risk geriatric and frail populations.
• Highlights the generally favorable outcomes of parathyroid and thyroid surgery in vulnerable patients.
• Emphasizes the need for individualized treatment planning for adrenal and GEP-NET surgeries in complex cases.