Liver and Pancreatic Resection in the Elderly

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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Comparison of prognosis between emergency and scheduled hemodialysis

Journal of International Medical Research ◽

10.1177/0300060518807092 ◽

2019 ◽

Vol 47 (3) ◽

pp. 1221-1231 ◽

Cited By ~ 2

Author(s):

Zhixiang Bian ◽

Huiyi Gu ◽

Peihua Chen ◽

Shijian Zhu

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Mortality Rate ◽

Serum Creatinine ◽

Survival Rates ◽

Overall Survival Rate ◽

Short Term ◽

Term Survival ◽

Renal Replacement Therapies

Background The survival rate of patients undergoing hemodialysis and other renal replacement therapies has been extensively studied, but comparative studies of emergency and scheduled hemodialysis are limited. Methods This study included 312 patients who underwent emergency hemodialysis and 274 who received scheduled hemodialysis. We investigated the prognostic differences between these two groups of patients, including the short-term and long-term survival rates. Results The overall survival rate was significantly better among the patients in the scheduled hemodialysis group than emergency hemodialysis group. The mortality rate within 3 months of emergency hemodialysis was 4.8%, while that within 3 months of scheduled hemodialysis was 1.1%. Conclusions Significant differences were present between emergency and scheduled hemodialysis, especially the levels of serum creatinine and hemoglobin.

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The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

International Surgery ◽

10.9738/intsurg-d-16-00192.1 ◽

2016 ◽

Vol 101 (11-12) ◽

pp. 554-561

Author(s):

Toru Aoyama ◽

Masaaki Murakawa ◽

Yosuke Atsumi ◽

Keisuke Kazama ◽

Manabu Shiozawa ◽

...

Keyword(s):

Elderly Patients ◽

Pancreatic Adenocarcinoma ◽

Pancreatic Resection ◽

The Elderly ◽

Surgical Mortality ◽

Long Term Outcomes ◽

Group A ◽

Short And Long Term ◽

Group B

The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been fully evaluated in elderly patients. This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into 2 groups: nonelderly patients (age < 75 years; group A) and elderly patients (age ≥ 75 years; group B). The surgical morbidity, surgical mortality, overall survival (OS), and recurrence-free survival (RFS) rates in the 2 groups were compared. A total of 221 patients were evaluated in the study. The overall complication rates were 44.8% in group A and 52.6% in group B. Surgical mortality was observed in 2 patients due to an abdominal abscess and cardiovascular disease in group A (1.1%) and in 1 patient due to postoperative bleeding in group B (2.6%). There were no significant differences (P = 0.379 and P = 0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and nonelderly patients (18.55 versus 20.2%, P = 0.946 and 13.1% versus 16.0%, P = 0.829, respectively). The short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the nonelderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

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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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How prolonged mechanical ventilation is a neglected disease in chest medicine: a study of prolonged mechanical ventilation based on 6 years of experience in Taiwan

Therapeutic Advances in Respiratory Disease ◽

10.1177/1753466619878552 ◽

2019 ◽

Vol 13 ◽

pp. 175346661987855

Author(s):

Chienhsiu Huang

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Survival Rate ◽

Mortality Rate ◽

Hospital Mortality ◽

Prolonged Mechanical Ventilation ◽

Survival Rates ◽

Term Survival ◽

Long Term Survival

Background: An increasing number of patients require prolonged mechanical ventilation (PMV) to survive recovery from critical care. It should be emphasized that PMV is a neglected disease in chest medicine. We investigated 6 years of clinical outcomes and long-term survival rates of patients who required PMV. Methods: We analyzed retrospectively data from patients in respiratory care center (RCC) to investigate the main causes of respiratory failure leading patients to require PMV. We also studied the factors that influence the ventilator weaned rate, factors that influence the long-term ventilator dependence of patients who require PMV, as well as patients’ hospital mortality and long-term survival rates. Results: A total of 574 patients were admitted to RCC during the 6 years. Of these, 428 patients (74.6%) were older than 65 years. A total of 391 patients (68.1%) were successfully weaned from the ventilator while 83 patients (14.4%) were unsuccessfully weaned. A total of 95 patients (16.6%) died during RCC hospitalization. The most common cause of acute respiratory failure leading to patients requiring PMV was pneumonia. The factor that affected whether patients were successfully weaned from the ventilator was the cause of the respiratory failure that lead patients to require PMV. Our hospital mortality rate was 32.4%; the 1-year survival rate was 24.3%. There was a strong correlation between higher patient age and higher hospital mortality rate and poor 1-year survival rate. Patients with no comorbidity demonstrated good 1-year survival rates. Patients with four comorbidities and patients with end-stage renal disease requiring hemodialysis comorbidity showed poor 1-year survival rates. Conclusions: The factor that affected whether patients were successfully weaned from the ventilator was the cause of the respiratory failure that lead patients to require PMV. Older patients, patients with renal failure requiring hemodialysis, and those with numerous comorbidities demonstrated poor long-term survival. The reviews of this paper are available via the supplemental material section.

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Improved short and long term survival associated with percutaneous coronary intervention in the elderly patients with acute coronary syndrome

BMC Geriatrics ◽

10.1186/s12877-018-0818-z ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Xiaojing Chen ◽

Salim Bary Barywani ◽

Runa Sigurjonsdottir ◽

Michael Fu

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Elderly Patients ◽

Coronary Intervention ◽

The Elderly ◽

Term Survival ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Short And Long Term

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The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients older than 75 years.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.470 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 470-470

Author(s):

Keisuke Kazama ◽

Toru Aoyama ◽

Yosuke Atsumi ◽

Masaaki Murakawa ◽

Manabu Shiozawa ◽

...

Keyword(s):

Elderly Patients ◽

Pancreatic Adenocarcinoma ◽

Pancreatic Resection ◽

The Elderly ◽

Complication Rates ◽

Long Term Outcomes ◽

Group A ◽

Short And Long Term ◽

Group B

470 Background: The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been evaluated in elderly patients. Methods: This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into two groups; non-elderly patients(age <75 years: group A) and non-elderly patients (age ≥75 years: group B). The surgical morbidity, motality, overall survival (OS), and recurrence-free survival (RFS) rates in the two groups were compared. Results: A total of 221 patients were evaluated in the study. The overall complication rates are 44.8% in Group A and 52.6% in Group B. Surgical mortality was observed in 2 patients due to an abdominal abcess and cardiovascular disease in Group A (1.1%) and in 1 patient due to postoperative bleeding in Group B (2.6%). There were no significant differences (p=0.379 and p=0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and non-elderly patients (18.55% vs. 20.2%, p=0.946 and 13.1% vs. 16.0%, p=0.829 respectively). Conclusions: The short-term outcomes and long-term outcomes survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the non-elderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

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

Frontline Gastroenterology ◽

10.1136/flgastro-2019-101294 ◽

2020 ◽

pp. flgastro-2019-101294

Author(s):

Thomas Skouras ◽

Ashley Bond ◽

Asimina Gaglia ◽

Laura Bonnett ◽

Meng Jiang Lim ◽

...

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

Endoscopic Mucosal Resection ◽

Colonic Polyps ◽

The Elderly ◽

Colorectal Polyps ◽

Term Survival ◽

Mucosal Resection ◽

Tertiary Centre

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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