Outcomes and adverse factors for endoscopic mucosal resection (EMR) of colorectal polyps in elderly patients

IntroductionEndoscopic mucosal resection (EMR) is an invaluable technique, however it is associated with significant risks. In the elderly in particular, the long-term survival benefits of polyp resection with EMR are unknown. The aim of this study was to determine the long-term outcomes in elderly patients who had undergone EMR and to identify any adverse factors.MethodA retrospective observational study on patients of 75 years of age or greater, who underwent EMR of colorectal polyps, in a single tertiary centre, from 2005 to 2014. Demographics of the patients, including Charlson Comorbidity Index (CCI), endoscopic and histological data, were reviewed to identify potential factors predicting outcomes.ResultsThe patients’ median age was 80 years. In total 239 procedures were performed in 206 unique patients. The complication rate was 1.6%. Mean overall survival was 6.7 years with only one patient dying from metastatic colorectal cancer (0.5%) and 49 dying from non-colorectal cancer conditions (24%). Age more than 79 years and CCI more than 2 were independent predictors of significantly shorter survival (p=<0.01). Gender, size of the removed polyps and total number of polyps were not statistically significantly affecting survival. Patients who had more than two colonoscopies were found to have a survival benefit (p=0.02).ConclusionEMR of colonic polyps is safe even for elderly patients. However, the decision to proceed to complex endoscopic therapy should be individualised considering the patients’ age and comorbidities. CCI can help to objectively assess the comorbid state of a patient prior to such decisions.

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Liver and Pancreatic Resection in the Elderly

HPB Surgery ◽

10.1155/1997/84160 ◽

1997 ◽

Vol 10 (4) ◽

pp. 259-261 ◽

Cited By ~ 2

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.

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Comparison of Outcomes Between McKeown and Sweet Esophagectomy in the Elderly Patients for Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

Cancer Control ◽

10.1177/1073274820904700 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482090470

Author(s):

Dongni Chen ◽

Yihuai Hu ◽

Youfang Chen ◽

Jia Hu ◽

Zhesheng Wen

Keyword(s):

Squamous Cell Carcinoma ◽

Propensity Score ◽

Esophageal Squamous Cell Carcinoma ◽

Elderly Patients ◽

Cell Carcinoma ◽

Squamous Cell ◽

The Elderly ◽

Perioperative Outcomes ◽

Term Survival

The aim of this study was to compare the perioperative outcomes and long-term survival rates of the McKeown and Sweet procedures in patients with esophageal cancer younger than 70 years or older than 70 years. A total of 1432 consecutive patients with esophageal squamous cell carcinoma (ESCC) who received surgery at Sun Yat-sen University Cancer Center from January 2009 to October 2012 were analyzed. Propensity score matching was used to balance the clinical characteristics of the patients who underwent different surgical approaches, and 275 and 71 paired cases were matched among those younger and older than 70 years, respectively. The prognosis and postoperative outcomes were compared between the McKeown and the Sweet esophagectomy. For patients younger than 70 years, those who underwent the McKeown procedure had better overall survival (OS) than those in the Sweet group (log rank = 4.467; P = .035). However, no significant difference in disease-free survival and OS was observed between two approaches for the elderly patients (log rank = 1.562; P = .211 and log rank = 0.668; P = .414, respectively). Cox regression analysis revealed that McKeown approach was a positive prognostic factor compared to the Sweet approach for patients younger than 70 years in univariable analysis (HR = 0.790; 95% CI, 0.625-0.997; P = .047), whereas the surgical approach was not significantly related to the prognosis in the elderly patients. For patients older than 70 years, the occurrence of anastomotic fistula increased in those who underwent the McKeown procedure (23.9% vs 11.3%, P = .038, for the McKeown and Sweet esophagectomy, respectively). The McKeown approach increases the OS in younger patients with ESCC. However, for patients older than 70 years, the Sweet approach was proven to be an effective therapy, given the better perioperative outcomes and similar long-term survival compared with patients in the McKeown group.

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Colorectal cancer in the elderly—surgical treatment and long-term survival

International Journal of Colorectal Disease ◽

10.1007/s00384-008-0457-5 ◽

2008 ◽

Vol 23 (6) ◽

pp. 601-610 ◽

Cited By ~ 26

Author(s):

L. Schiffmann ◽

S. Özcan ◽

F. Schwarz ◽

J. Lange ◽

F. Prall ◽

...

Keyword(s):

Colorectal Cancer ◽

Surgical Treatment ◽

The Elderly ◽

Term Survival ◽

Long Term Survival

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Successful salvage endoscopic mucosal resection for residual superficial hypopharyngeal carcinoma after chemoradiotherapy, with long-term survival

Endoscopy ◽

10.1055/s-0029-1214647 ◽

2009 ◽

Vol 41 (06) ◽

pp. 568-569 ◽

Cited By ~ 1

Author(s):

T. Yoshida ◽

Y. Shimizu ◽

S. Ono ◽

N. Oridate ◽

M. Kato ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Hypopharyngeal Carcinoma ◽

Term Survival ◽

Long Term Survival ◽

Mucosal Resection

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Morbidity and Mortality of C2 Fractures in the Elderly

Neurosurgery ◽

10.1227/neu.0b013e3182446742 ◽

2011 ◽

Vol 70 (5) ◽

pp. 1055-1059 ◽

Cited By ~ 12

Author(s):

Yi-Ren Chen ◽

Maxwell Boakye ◽

Robert T. Arrigo ◽

Paul S. A. Kalanithi ◽

Ivan Cheng ◽

...

Keyword(s):

Elderly Patients ◽

Hospital Stay ◽

Treatment Modality ◽

The Elderly ◽

Morbidity And Mortality ◽

High Morbidity ◽

Complication Rates ◽

Term Survival ◽

Cord Injury

Abstract BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients. OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality. METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival. RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups. CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

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