PS01.181: ESOPHAGECTOMY FOR ESOPHAGEAL CARCINOMA TO ELDERLY PATIENTS OVER 75 YEARS OLD

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 100-101
Author(s):  
Naoto Ujiie ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Chiaki Sato ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Survival Rate ◽  
Elderly Patients ◽  
Esophageal Carcinoma ◽  
Operation Time ◽  
The Elderly ◽  
Elderly Group ◽  
Control Group ◽  
And Control

Abstract Background Recently, operation cases of elderly patients are increasing in esophageal carcinoma. Because elderly patients often have pre-existing disease and may easily cause postoperative complications, it is necessary to consider whether surgical treatment is appropriate for those elderly patients. The aim of this study is to investigate the safety of esophagectomy for elderly patients with esophageal carcinoma. Methods All 483 patients who underwent esophagectomy for esophageal carcinoma between April 2007 and March 2015 were included in this study. Patients were divided into two groups: elderly group (over 75 years old: n = 72) and control group (under 75 years old: n = 411). The short and long-term outcomes were retrospectively examined to those groups. Results In the elderly group, their median age was 77 [75–85] and all of their performance status was 0 or 1, except 4 patients. 66 cases of the elderly group had some comorbidity, which was significantly higher than that of the control group (93.0 vs. 80.2%, P = 0.007). Pre-surgical treatment was performed to 38.9% of the elderly group, whereas 58.9% in the control group (P = 0.002). No significant differences were demonstrated in clinical stage, occupation site, histological type and pathological stage between these groups. The operation time was relatively shorter in the elderly group compare to the control group (549 vs. 585min, P = 0.018). The number of dissected lymph node was also smaller in elderly group (31 vs. 35, P = 0.048). The postoperative complications such as pneumonia, recurrent laryngeal nerve paralysis did not show any difference between these groups. The 5-year overall survival rate (OS) and the 5-year disease specific survival rate (DSS) also did not show statistical differences between the elderly and control group (OS: 53.0 vs. 57.0%, P = 0.765; DSS: 64.6 vs. 62.7%, P = 0.605). Conclusion Between elderly and control group, there was no difference in postoperative complication and long-term survival. This study confirmed the safety of esophagectomy for elderly patients with esophageal carcinoma by reducing treatment stress such as neoadjuvant therapy, extended operation time and extensive lymphadenectomy. Disclosure All authors have declared no conflicts of interest.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

scholarly journals Liver and Pancreatic Resection in the Elderly

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 259-261 ◽  
Author(s):  
O. J. Garden
Keyword(s):  
Survival Rate ◽  
Liver Resection ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Complication Rate ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Term Survival ◽  
Pancreatic Resections

Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.Methods: Five hundred seventy-seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5-year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long-term survival was poorer for the elderly patients, with a 5-year survival rate of 21% compared with 29% for the younger cohort (p=0.03).Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.

Radical Cystectomy in Elderly Patients

1993 ◽  
Vol 60 (1) ◽  
pp. 19-22
Author(s):  
P. Bassi ◽  
M. Gholam Alipour ◽  
G.L. Drago Ferrante ◽  
N. Piazza ◽  
N. Panza ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Length Of Hospital Stay ◽  
Wound Dehiscence ◽  
The Elderly ◽  
Elderly Group ◽  
Medical Complications ◽  
Control Group ◽  
Pelvic Hematoma

Radical cystectomy is the most common treatment for deeply invasive bladder cancer; due to reported operative risks, concerns have been expressed regarding the suitability of this operation in elderly patients. We reviewed the morbility and mortality rates in 50 patients aged 70 years and over (elderly group), undergoing radical cystectomy and urinary diversion, to verify if this procedure could be considered as initial treatment in older-age patients. The findings were compared with those observed in 50 patients aged 40 to 69 years (control group). In the elderly group there was no operative mortality; however 2 patients (4%) died post-operatively due to pulmonary embolism and multi-organ-failure syndrome respectively. Four patients (8%) were re-operated due to intestinal obstruction (2 pts), pelvic hematoma (1 pt) and wound dehiscence (1 pt). Wound separation was the more frequent complication (15%); 6% of patients experienced extended intestinal atonia. The length of hospital stay was 17.1 days. In the control group, surgical complications were comparable to those observed in the elderly group: furthermore medical complications were more frequent. In conclusion, these data suggest that radical cystectomy and urinary diversion can be safely performed in the elderly. Radical surgery is an effective treatment modality for elderly individuals who are in reasonably good general health. A higher incidence of medical complications must be expected in elderly patients.

scholarly journals The Relationship between Smoking and Sublingual Varices in the Elderly

2021 ◽  
Vol 36 (4) ◽  
pp. e288-e288
Author(s):  
Niusha Barzideh ◽  
Arezoo Alaee ◽  
Arash Azizi
Keyword(s):  
Older Adults ◽  
Cigarette Smoking ◽  
Elderly Patients ◽  
Varicose Veins ◽  
The Elderly ◽  
Control Group ◽  
Case Group ◽  
Chi Square ◽  
Number Of Patients ◽  
And Control

Objectives: We investigated the existence of any connection between smoking and sublingual varices (SLV) in the older population. Methods: This case-control study was conducted in 2019 on adults > 65 years old at Kahrizak Charity Nursing Home, Alborz, Iran. We conducted clinical examination and inspection of 222 elderly patients. Both the case group and control group contained the same number of patients (n = 111). SLV were classified as grade 0 (few or none visible) and grade 1 (moderate or severe). The case group included patients with SLV and the control group consisted of those older adults without SLV and who were matched with the case group based on age, gender, blood pressure, denture wearing, and varicose veins in their legs. Cigarette smoking habits were investigated in both groups. Smokers were considered those who smoked at least one cigarette per day for more than six months. Chi-square and odds ratio (OR) were used to statistically analyze the exposure of participants to smoking in both groups. Results: Among 222 participants, 21.6% and 5.4% were smokers in the case and control groups, respectively. The results of our data analysis revealed that SLV were significantly associated with smoking (p < 0.001, OR = 4). Conclusions: Elderly patients with SLV are more likely to be cigarette smokers. Therefore, cigarette smoking cessation programs are recommended for older adults in society.

scholarly journals Prehabilitation Program in Elderly Patients: A Prospective Cohort Study of Patients Followed Up Postoperatively for Up to 6 Months

2021 ◽  
Vol 10 (19) ◽  
pp. 4500
Author(s):  
Claire Malot ◽  
Astrid Durand-Bouteau ◽  
Nicolas Barizien ◽  
Antoine Bizard ◽  
Titouan Kennel ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
The Elderly ◽  
Elderly Group ◽  
Control Group ◽  
Functional Capabilities ◽  
Observational Cohort ◽  
6 Minute Walk Test ◽  
The Impact ◽  
Minute Walk

The preoperative period may be an opportune period to optimize patients’ physical condition with a multimodal preoperative program. The impact of a “prehabilitation” program on elderly patients is discussed. This mono-center observational cohort study included consecutively 139 patients planned for major abdominal and thoracic surgery, with 44 in the control group (age < 65) and 95 in the elderly group (age > 65). All patients followed a “prehabilitation” program including exercise training, nutritional optimization, psychological support, and behavioral change. Seventeen patients in the control group and 45 in the elderly group completed the study at six months. The 6-minute walk test (6 MWT) increased in both groups from the initial evaluation to the last (median value of 80 m (interquartile range 51) for those under 65 years; 59 m (34) for the elderly group; p = 0.114). The 6 MWT was also similar after one month of prehabilitation for both populations. The rate of postoperative complications was similar in the two groups. Prehabilitation showed equivalence in patients over 65 years of age compared to younger patients in terms of increase in functional capabilities and of postoperative evolution. This multimodal program represents a bundle of care that can benefit a frailer population.

scholarly journals SURGICAL TREATMENT OF ATRIAL FIBRILLATION IN ELDERLY PATIENTS UNDERGOING HIGH RISK CARDIAC SURGERY

2021 ◽  
Author(s):  
Mohsin Uzzaman ◽  
Imthiaz Manoly ◽  
Mohini Panikkar ◽  
Maciej Matuszewski ◽  
Nicolas Nikolaidis ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Surgical Treatment ◽  
High Risk ◽  
Elderly Patients ◽  
Control Group ◽  
Surgical Ablation ◽  
Af Ablation

BACKGROUND/AIM To evaluate outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation 2. No-Surgical AF treatment. Patients requiring redo procedures or those who had isolated PVI or LAAO were excluded. Heart rhythm assessed from Holter reports or 12-lead ECG. Follow-up data collected through telephone consultations and medical records. RESULTS There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%) patient in Cox maze group with 30-day mortality compared to 14 (8.2%) the control group (p=0.05). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - significantly better than No-Surgical AF treatment groups (P<0.001). 160 patients (66.9%) were alive at long-term follow-up with better survival curves in Cox Maze group compared to No-Surgical treatment group (p=0.02). There was significantly higher proportion of patients in NYHA 1 status in Cox-Maze group (p=0.009). No differences observed in freedom from stroke (p=0.80) or permanent pacemaker (p=0.33). CONCLUSIONS. Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic/prognostic benefits. Therefore, surgical risk need not be reason to deny benefits of concomitant AF-ablation.

scholarly journals Efficacy, safety, and adherence of tocilizumab therapy in elderly patients with rheumatoid arthritis: A real-world observational study

2021 ◽  
Vol 19 ◽  
pp. 205873922110457
Author(s):  
Yoshinobu Nakao ◽  
Yu Funakubo Asanuma ◽  
Takuma Tsuzuki Wada ◽  
Mayumi Matsuda ◽  
Hiroaki Yazawa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Survival Rate ◽  
Elderly Patients ◽  
Disease Activity ◽  
Activity Index ◽  
The Elderly ◽  
Young Group ◽  
Elderly Group ◽  
Drug Survival ◽  
Significant Difference

Objective: We evaluated the efficacy, safety, and drug survival rate of tocilizumab in the elderly patients with rheumatoid arthritis (RA). Methods: This study was conducted in 108 RA patients who started tocilizumab between 2008 and 2018. The patients were divided into a young group (<65 years) and an elderly group (≥65 years). The efficacy, safety, and drug survival rate of tocilizumab were compared between the two groups. Results: At baseline, there were no significant differences between the elderly ( n = 45) and the young group ( n = 63) in RA duration, percentage of biologic-naïve, and RA disease activity. Health Assessment Questionnaire-Disability Index (HAQ-DI) was higher, renal function was worse, and frequency of using methotrexate was lower in the elderly group. Tocilizumab demonstrated similar efficacy in the elderly and the young group with Clinical Disease Activity Index and HAQ-DI. Compared with baseline, the frequency of steroid use was lower at one year after initiation of tocilizumab in both groups. There was no significant difference between the groups in the drug survival rate of tocilizumab for three years. Discontinuation rates of TCZ due to toxic adverse events were similar between the two groups. Conclusions: The efficacy, steroid-sparing effect, and safety of tocilizumab therapy, as well as the drug survival rate for three years, were not inferior in elderly RA compared to young RA patients.

scholarly journals Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study

2020 ◽  
Vol 19 ◽  
pp. 153303382097033
Author(s):  
Hengchang Liu ◽  
Chunxiang Li ◽  
Zhixun Zhao ◽  
Xu Guan ◽  
Ming Yang ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
The Elderly ◽  
Locally Advanced Rectal Cancer ◽  
Term Effect ◽  
Elderly Group ◽  
Long Term Effect

Introduction: Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC. Method: Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients were in the elderly group (≥ 65 years old) and 306 patients were in the non-elderly group (<65 years old). The side effects, toxicity, complications, disease-free survival (DFS), and overall survival (OS) of all of the patients were assessed. Results: The data comprised 103 patients in the elderly group and 292 patients in the non-elderly group who completed nCRT sessions following operation. The treatment-completion rates of the elderly and non-elderly groups were 95.37% and 95.42%, respectively. Twenty-two patients developed radiotherapy complications (grade III) in the elderly group and 37 such cases developed in the non-elderly group. Diarrhea, skinulcer, and perianal pain were ranked as the top 3 most common complications. The incidence of infection, anastomotic leakage, and intestinal obstruction was 0.97% in the elderly group. The 5-year DFS and 5-year OS rate were 70.7% and 80.8% in the elderly group, 67.3% and 81.6% in the non-elderly group respectively. Conclusions: nCRT are safe and effective for elderly patients, and it does not increase the risk of postoperative complications for the elderly. Hence, nCRT should not be withheld based on age alone.

The results of surgical treatment of the patients with a cochlear form of otosclerosis

2019 ◽  
Vol 18 (5) ◽  
pp. 46-53
Keyword(s):  
Surgical Treatment ◽  
Bone Conduction ◽  
Functional Results ◽  
Main Group ◽  
Differential Diagnostics ◽  
Control Group ◽  
Efficient Treatment ◽  
And Control

Despite the progress in otosurgery, the efficient treatment of patients with the cochlear form of otosclerosis (according to the classification of N.A. Preobrazhensky, 1962) remains an important task. The authors have developed and implemented an advanced stapedoplasty method, providing the improvement of hearing in this category of patients. and described the methods of differential diagnostics for selection of patients according to the developed method. The article describes in details the early and long-term functional results of surgical treatment of 60 patients with cochlear and mixed II forms of otosclerosis, divided into the main and control groups. The main group is represented by 30 patients who underwent a cartilage-on-vein stapedoplasty according to the improved method. The control group included 30 patients, in which 18 people underwent a cartilage-on-vein stapedoplasty according to the method developed by Lenin Prize winner V. F. Nikitina, and 12 people who underwent V. T. Palchun’s piston stapedoplasty. The results demonstrate a statistically significant improvement of bone conduction in the main group in average by 15–20 dB throughout the entire tone scale (except for high frequencies in some patients) and the complete closure of the bone-air interval with subsequent preservation of the results. Based on the obtained data, the authors present the expediency and perspectivity of implementation of the advanced stapedoplasty method.

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 (&lt;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.

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