551 INCREASED POSTOPERATIVE MORBIDITY AFTER TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY FOR CANCER IN ELDERLY PATIENTS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Nikolaj Baranov ◽  
Nikolaj Baranov ◽  
Frans Van Workum ◽  
Camiel Rosman
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Minimally Invasive Esophagectomy ◽  
Age Groups ◽  
The Elderly ◽  
Elderly Group ◽  
Younger Patients ◽  
Invasive Esophagectomy ◽  
Outcome Parameters ◽  
Increased Risk

Abstract   The incidence of elderly patients with esophageal cancer is increasing. The aim of this study is to compare postoperative outcomes after esophagectomy between elderly patients and younger patients and to compare outcomes after totally minimally invasive esophagectomy (TMIE) and open esophagectomy (OE) in these age groups. Methods Data was retrieved from the Dutch Upper Gastrointestinal Cancer Audit (DUCA), a national surgical outcome registry. The primary outcome parameter was severe complications, defined as Clavien Dindo ≥3. Secondary outcome parameters were postoperative complications, reintervention rate, length of hospital stay and mortality. Outcome parameters were compared between patients aged ≥75 years and < 75 years and between TMIE and OE in these age groups. We adjusted for the following casemix parameters: gender, Charlson Co-morbidity Index score ASA score and neoadjuvant therapy. A sensitivity analysis was performed with different age groups: <65, 65–69, 70–74, 75–79 and ≥ 80 years. Results Of all 5539 included patients 14.0% were aged ≥75 years and 86.0% were aged <75 years. Severe complications were observed more frequently in the elderly group compared to the younger group (RR = 1.15 [1.04–1.27], p = 0.007). Interestingly, there was an increased risk of severe complications after TMIE in both the elderly group (RR = 1.50 [1.19–1.90], p = 0.001) and the younger group (RR = 1.41 [1.28–1.56], p < 0.001). No difference in mortality between TMIE and OE was found. Sensitivity analyses of TMIE compared to OE across all age groups showed increased risk of severe complications. Adjustment for casemix for all analysis did not change the results. Conclusion Severe complications after esophagectomy occur more frequently in elderly compared to younger patients. TMIE in elderly patients did not result in less morbidity and was in fact associated with more severe complications compared to OE across all age groups, which may be due to a learning curve effect.

Safety and feasibility of minimally invasive esophagectomy for elderly esophageal cancer patients

2020 ◽  
Author(s):  
Y Sugita ◽  
T Nakamura ◽  
R Sawada ◽  
G Takiguchi ◽  
N Urakawa ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Minimally Invasive Esophagectomy ◽  
The Elderly ◽  
Elderly Group ◽  
Hospital Death ◽  
Cancer Specific Survival ◽  
Invasive Esophagectomy ◽  
Short And Long Term

Summary The number of elderly patients with esophageal cancer has increased in recent years. The use of thoracoscopic esophagectomy has also increased, and its minimal invasiveness is believed to contribute to postoperative outcomes. However, the short- and long-term outcomes in elderly patients remain unclear. This study aimed to elucidate the safety and feasibility of minimally invasive esophagectomy in elderly patients. This retrospective study included 207 patients who underwent radical thoracoscopic esophagectomy for thoracic esophageal squamous cell carcinoma at Kobe University Hospital between 2005 and 2014. Patients were divided into non-elderly (<75 years) and elderly (≥75 years) groups. A propensity score matching analysis was performed for sex and clinical T and N stage, with a total of 29 matched pairs. General preoperative data, surgical procedures, intraoperative data, postoperative complications, in-hospital death, cancer-specific survival, and overall survival were compared between groups. The elderly group was characterized by lower preoperative serum albumin levels and higher American Society of Anesthesiologists grade. Intraoperative data and postoperative complications did not differ between the groups. The in-hospital death rate was 4% in the elderly group, which did not significantly differ from the non-elderly group. Cancer-specific survival was similar between the two groups. Although overall survival tended to be poor in the elderly group, it was not significantly worse than that of the non-elderly group. In conclusion, the short- and long-term outcomes of minimally invasive esophagectomy in elderly versus non-elderly patients were acceptable. Minimally invasive esophagectomy is a safe and feasible modality for elderly patients with appropriate indications.

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

Cochlear implantation in elderly patients: stability of outcome over time

2016 ◽  
Vol 130 (8) ◽  
pp. 706-711 ◽  
Author(s):  
O Hilly ◽  
E Hwang ◽  
L Smith ◽  
D Shipp ◽  
J M Nedzelski ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cochlear Implantation ◽  
Short Form ◽  
Age Groups ◽  
The Elderly ◽  
Long Term Results ◽  
Profound Hearing Loss ◽  
Younger Patients ◽  
Over Time

AbstractBackground:Cochlear implantation is the standard of care for treating severe to profound hearing loss in all age groups. There is limited data on long-term results in elderly implantees and the effect of ageing on outcomes. This study compared the stability of cochlear implantation outcome in elderly and younger patients.Methods:A retrospective chart review of cochlear implant patients with a minimum follow up of five years was conducted.Results:The study included 87 patients with a mean follow up of 6.8 years. Of these, 22 patients were older than 70 years at the time of implantation. Hearing in Noise Test scores at one year after implantation were worse in the elderly: 85.3 (aged under 61 years), 80.5 (61–70 years) and 73.6 (aged over 70 years;p= 0.039). The respective scores at the last follow up were 84.8, 85.1 and 76.5 (p= 0.054). Most patients had a stable outcome during follow up. Of the elderly patients, 13.6 per cent improved and none had a reduction in score of more than 20 per cent. Similar to younger patients, elderly patients had improved Short Form 36 Health Survey scores during follow up.Conclusion:Cochlear implantation improves both audiometric outcome and quality of life in elderly patients. These benefits are stable over time.

PS01.218: MORBIDITY AND MORTALITY IN ELDERLY PATIENTS AFTER MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 112-112
Author(s):  
Jeroen Hol ◽  
Joos Heisterkamp ◽  
Barbara Langenhoff
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Length Of Hospital Stay ◽  
Morbidity And Mortality ◽  
Tumor Type ◽  
Invasive Esophagectomy ◽  
Group 2 ◽  
Group 1

Abstract Background Elderly patients undergoing gastrointestinal surgery are at higher risk for postoperative complications and mortality. Currently available literature on elderly patients undergoing an esophagectomy is inconclusive and dates back from the time before minimally invasive techniques were implemented. Methods Length of hospital stay, 90-day morbidity and mortality were analyzed from patients undergoing minimally invasive esophagectomy (MIE) between 2014 and 2017 in a single center. Data from patients aged 76 years or older was compared to the cohort of patients aged 71 to 75 years old. Results From a consecutive series of in total 187 patients two cohorts were retrieved: 19 patients 76 years or older (group 1) were compared to 41 patients 71 to 75 years old (group 2). Median age was 77 years (76–83) in group 1 and 72 years (71–75) in group 2 (P < 0.05). There were no significant differences in sex, Charlson comorbidity score, number of patients undergoing neoadjuvant chemoradiaton, histological tumor type, tumor stage, number of lymph nodes harvested and type of anastomosis. There were no significant differences in length of hospital stay, 90-day morbidity and mortality. The percentage of anastomotic leakage was 21.2% in group 1 and 14.6% in group 2. Mortality was 10.5% and 4.9% respectively. Conclusion No difference was seen in morbidity and mortality after MIE comparing the eldest old to younger old patients. Therefore, patient selection should not be based on calendar age alone. Disclosure All authors have declared no conflicts of interest.

Minimally invasive esophagectomy can be performed safely in the elderly population

2007 ◽  
Vol 205 (3) ◽  
pp. S23-S24
Author(s):  
Anna R. Ibele ◽  
Anna Ibele ◽  
James Maloney ◽  
David Mahvi ◽  
Tracey L. Weigel
Keyword(s):  
Minimally Invasive ◽  
Elderly Population ◽  
Minimally Invasive Esophagectomy ◽  
The Elderly ◽  
Invasive Esophagectomy

Elderly CML Patients On Early Applied High Dose Imatinib Achieve Molecular Remissions As Fast As Younger Patients In Contrast To Patients On Standard Dose Imatinib: A Subanalysis Of The German CML-Study IV

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 96-96 ◽  
Author(s):  
Ulrike Proetel ◽  
Nadine Pletsch ◽  
Michael Lauseker ◽  
Lida Kalmanti ◽  
Annette Schreiber ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Research Funding ◽  
Standard Dose ◽  
Age Groups ◽  
The Elderly ◽  
Median Dose ◽  
Molecular Remission ◽  
Who Grade ◽  
Younger Patients ◽  
Treatment Groups

Abstract Introduction The outcome of elderly patients with chronic myeloid leukemia (CML) treated with imatinib has been studied in several trials. However, there are no reports on the effects of different imatinib dosages in older vs. younger CML patients. Methods To evaluate the efficacy of imatinib in the elderly, we analyzed data from the German CML-Study IV, a randomized 5-arm trial designed to optimize imatinib therapy alone or in combination. There was no upper age limit for inclusion. Patients with BCR-ABL positive CML in chronic phase randomized to imatinib 400 mg/d (IM400) or imatinib 800 mg/d (IM800) were compared, stratified according to median age at diagnosis in western populations ≥ 65 years vs. < 65 years, regarding effectively administered imatinib dose, time to hematologic, cytogenetic and molecular remissions, adverse events (AEs), rates of progression to accelerated phase (AP) and blast crisis (BC), survival, and causes of death. The full 800 mg dose was given after a 6 weeks run-in period with imatinib 400 mg/d to avoid excessive cytopenias. The dose could then be reduced according to tolerability for maximum patients' compliance. Results From July 2002 through March 2012, 1,551 patients were randomized, 828 of these to IM400 or IM800. Median age of these patients was 52 years (IM400: 53 years; IM800: 51 years). 784 patients were evaluable for follow-up (IM400: 382; IM800: 402). 193 patients were ≥ 65 years, 591 < 65 years. 110 patients (29%) on IM400 and 83 (21%) on IM800 were ≥ 65 years. Median observation time on IM400 was 63.0 months in the elderly and 67.6 months in the younger group, on IM800 50.9 months in the elderly and 50.1 months in the younger group. The median dose per day was lower for elderly patients on IM800 (421 mg/d for patients ≥ 65 years vs. 556 mg/d for patients < 65 years), with the highest median dose in the first year (466mg/d for patients ≥ 65 years vs. 630mg/d for patients < 65 years). The median dose for patients on IM400 was 400 mg/d for both age groups. There was no difference between age groups in achieving a complete hematologic remission or a complete cytogenetic remission, neither if IM400 and IM800 were combined, nor in an analysis according to treatment groups. Elderly patients on IM400 achieved major molecular remission (MMR) and deep molecular remission (MR4) significantly later than younger patients (18.1 vs. 15.9 months, p=0.013; 54.4 vs. 33.3 months, p=0.012, respectively) whereas no difference was detected for patients on IM800 (11.9 vs. 10.5 months; 24.2 vs. 26.1 months, respectively). Imatinib was well tolerated in elderly patients with only few WHO grade 3-4 AEs being more frequent in the elderly than in younger patients (dermatologic AEs on IM400: 5.4 vs. 0.4%; infections on IM800: 8.3 vs. 2.5%). There were no significant differences between age groups in probabilities of progression to AP or BC neither if IM400 and IM800 were combined, nor in an analysis according to treatment groups. Five-year age-adjusted relative survival for elderly patients was comparable to that of younger patients. Conclusion We could demonstrate that elderly patients achieved molecular remissions significantly later when treated with standard dose imatinib but not when treated with higher imatinib dosages. As the safety profile of IM800 in senior patients was favorable too we conclude, that the optimal dose for elderly patients could be higher than 400 mg/d. Disclosures: Müller: Ariad: Consultancy, Honoraria, Research Funding; BMS: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Hochhaus:Pfizer: Consultancy; ARIAD: Consultancy, Honoraria; BMS: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding, Travel Other. Hehlmann:BMS: Consultancy, Research Funding; Novartis: Research Funding. Saussele:BMS: Honoraria, Research Funding, Travel, Travel Other; Pfizer: Honoraria; Novartis: Honoraria, Research Funding, Travel Other.

Can a conventional schedule of radiation therapy be administered to elderly patients with glioblastoma multiforme?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 12516-12516
Author(s):  
S. Manfrida ◽  
G. R. D’Agostino ◽  
C. Anile ◽  
G. Mantini ◽  
G. Colicchio ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Elderly Patients ◽  
Conformal Radiotherapy ◽  
Residual Tumor ◽  
The Elderly ◽  
Elderly Group ◽  
Female Ratio ◽  
Younger Patients ◽  
Tumor Bed ◽  
Grade 3

12516 Background: We retrospectively evaluate the tolerance and the efficacy of a conventional schedule of radiotherapy in elderly patients with glioblastoma multiforme (GBM). Methods: Eighty-three consecutive patients affected by glioblastomas were treated between 2001 and 2006. We divided our series in two groups: patients under 65 years (n=52) and patients ≥ 65 years old (n=31). In the elderly group, median age was 68 years (range, 65–80). 17 patients (54,8%) were female, 14 male (45,2%); 20 patients (64,5%) <70 years, 11 patients (35,5%) ≥70 years. Among the younger patients, median age was 51 years (range 25–64), male/female ratio 32/20 (61.5%/38.5%).Twenty-seven out of 31 elderly patients (87,1%) were treated with conformal radiotherapy (CRT, 5940 cGy, 180 cGy/day; CTV2: tumor bed + residual tumor if present + oedema, 3960 cGy; CTV1: tumor bed + residual tumor if present + margins, 1980 cGy). Four out of 31 patients received an intensification dose of xxxx cGy by stereotactic conformal radiotherapy (SRT, 12,9%); among the younger patients, 25/52 were treated with CRT (48,1%) and 27/52 with SRT (51,9%). Concomitant and adjuvant chemotherapy was administered by temozolomide (TMZ).Toxicity was evaluated according to RTOG score. Survival analysis were performed using Kaplan-Meier method and log-rank testing was used for comparison of groups. Results: In the elderly group, neurological acute toxicity was observed in 6/31 patients (19,4%), with grade 3 in two patients. In the under 65 group, 5/52 patients (9,6%) had neurotoxicity (Grade 3 in two patients).This difference was not statistically different.At a median follow-up period of 28 months (range, 3–61), median progression-free survival (PFS) was 11 months in the ≥65 group and 10 months in the under 65 group; median overall survival (OS) was respectively 17 months and 22 months. 1- year survival was respectively 77.6% and 74.5%. Conclusions: In our analysis age did not seem to be a limiting factor in the choice of the therapeutic strategy for patients with glioblastoma multiforme. No significant financial relationships to disclose.

scholarly journals Minimally Invasive Esophagectomy in the Elderly

2013 ◽  
Vol 4 (4) ◽  
pp. 326-331 ◽  
Author(s):  
Shailesh Puntambekar ◽  
Rahul Kenawadekar ◽  
Archit Pandit ◽  
Akshay Nadkarni ◽  
Saurabh Joshi ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
The Elderly ◽  
Invasive Esophagectomy

scholarly journals Characteristics of factors for decreased lung function in elderly patients with type 2 diabetes

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Masaki Ishii ◽  
Yasuhiro Yamaguchi ◽  
Hironobu Hamaya ◽  
Sumito Ogawa ◽  
Mitsuo Imura ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Elderly Patients ◽  
Respiratory Function ◽  
Age Groups ◽  
The Elderly ◽  
Forced Expiratory Volume ◽  
Elderly Group ◽  
Female Sex ◽  
High Bmi

AbstractChronic obstructive pulmonary disease (COPD) often accompanies type 2 diabetes mellitus (T2DM). However, background factors affecting these diseases in the elderly remain unclear. Eligible patients with T2DM were divided into two age groups—non-elderly (<65 years) and elderly (≥65 years); COPD, ratio of forced expiratory volume in one second to forced expiratory volume (FEV1/FVC ratio), and percent predicted forced expiratory volume in one second (FEV1% predicted) were examined, and factors related to reduced respiratory function according to age group were evaluated. In total, 371 patients with T2DM were analysed. COPD was found in 9 patients (5.3%) in the non-elderly group and 45 (22.5%) in the elderly group. In the elderly, male sex, low body mass index (BMI), insulin therapy, and high C-peptide immunoreactivity levels were factors related to COPD. In the non-elderly, age, female sex, high BMI were factors related to decreased FEV1% predicted. Female sex was factor related to decreased FEV1% predicted in both age groups. Low BMI was a factor related to reduced respiratory function in elderly patients and high BMI was a factor related to reduced respiratory function in non-elderly patients. Thus, BMI needs to be managed according to the age and general condition of T2DM patients.

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