Typical trigeminal neuralgia in patients older than 65: Safety and efficacy of microvascular decompression by the retrosigmoid approach

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Luciano Mastronardi ◽  
Franco Caputi ◽  
Alessandro Rinaldi ◽  
Guglielmo Cacciotti
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Retrosigmoid Approach ◽  
Csf Leak ◽  
Old Patients ◽  
Younger Patients ◽  
Significant Difference

AbstractOBJECT: Incidence of typical trigeminal neuralgia (TN) increases with age and neurologists and neurosurgeons frequently observe patients with this disorder at the age of 65 or more. Microvascular decompression (MVD) of the trigeminal root entry zone in posterior cranial fossa is the only etiological therapy for typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus, the safety of MVD in the elderly remains non definitively demonstrated. This study was conducted to determine whether MVD is a safe and effective treatment in elderly patients with TN in comparison to younger patients.METHODS: In this retrospective study, 25 patients older than 65 (mean age 70.1 ± 3.7 years) and 32 aging <65 (mean age 51.1 ± 6.2 years) underwent MVD by key-hole retrosigmoid approach for Type 1 TN (typical) or Type 2a TN (typical chronicized) from November 2011 to November 2016. A 75 y-o patient had Type 2b TN (atypical) versus 3 nonelderly patients were excluded. Elderly and younger groups were compared in relation to outcome and complication data.RESULTS: At a mean follow-up 23.0 ± 5.5 months, 22 old patients (88%) reported a very good outcome without necessity of any medication for pain, versus 28 (87,5%) of the younger group. Twenty elderly patients with Type 1 TN were compared with 24 younger patients with Type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with Type 2a TN were compared with 8 younger patients with Type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of CSF leak and one case of cerebellar hematoma both in the younger cohort. Mortality was zero in both groups.CONCLUSIONS: On the basis of our experience and of the international literature, age itself seems not to represent a major contraindication against MVD for TN. Keywords: Elderly, Microvascular Decompression, Retrosigmoid approach, Trigeminal neuralgia, Tic douloureux

Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Years Operated on with Microvascular Decompression by Retrosigmoid Approach

2019 ◽  
Vol 81 (01) ◽  
pp. 028-032 ◽  
Author(s):  
Luciano Mastronardi ◽  
Franco Caputi ◽  
Alessandro Rinaldi ◽  
Guglielmo Cacciotti ◽  
Raffaelino Roperto ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Microvascular Decompression ◽  
Cerebrospinal Fluid Leak ◽  
The Elderly ◽  
Retrosigmoid Approach ◽  
Younger Patients ◽  
Significant Difference ◽  
Elderly Cohort

Abstract Objective The incidence of typical trigeminal neuralgia (TN) increases with age, and neurologists and neurosurgeons frequently observe patients with this disorder at age 65 years or older. Microvascular decompression (MVD) of the trigeminal root entry zone in the posterior cranial fossa represents the etiological treatment of typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus the safety of MVD in the elderly remains a topic of discussion. This study was conducted to determine whether MVD is a safe and effective treatment in older patients with TN compared with younger patients. Methods In this retrospective study, 28 patients older than 65 years (elderly cohort: mean age 70.9 ± 3.6 years) and 38 patients < 65 years (younger cohort: mean age 51.7 ± 6.3 years) underwent MVD via the keyhole retrosigmoid approach for type 1 TN (typical) or type 2a TN (typically chronic) from November 2011 to November 2017. A 75-year-old patient and three nonelderly patients with type 2b TN (atypical) were excluded. Elderly and younger cohorts were compared for outcome and complications. Results At a mean follow-up 26.0 ± 5.5 months, 25 patients of the elderly cohort (89.3%) reported a good outcome without the need for any medication for pain versus 34 (89.5%) of the younger cohort. Twenty-three elderly patients with type 1 TN were compared with 30 younger patients with type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with type 2a TN were compared with eight younger patients with type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of cerebrospinal fluid leak and one of a cerebellar hematoma, both in the younger cohort. Mortality was zero in both cohorts. Conclusions On the basis of our experience and the international literature, age itself does not seem to represent a major contraindication of MVD for TN.

Microvascular decompression for trigeminal neuralgia in elderly patients

2008 ◽  
Vol 108 (4) ◽  
pp. 689-691 ◽  
Author(s):  
Raymond F. Sekula ◽  
Edward M. Marchan ◽  
Lynn H. Fletcher ◽  
Kenneth F. Casey ◽  
Peter J. Jannetta
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Outcome Data ◽  
Control Group ◽  
Younger Patients ◽  
Telephone Interviews ◽  
Second Tier

Object Although microvascular decompression (MVD) for patients with medically refractory trigeminal neuralgia (TN) is widely accepted as the treatment of choice, other “second-tier” treatments are frequently offered to elderly patients due to concerns regarding fitness for surgery. The authors sought to determine the safety and effectiveness of MVD for TN in patients older than 75 years of age. Methods The authors performed a retrospective review of medical records and conducted follow-up telephone interviews with the patients. The outcome data from 25 MVD operations for TN performed in 25 patients with a mean age of 79.4 years (range 75–88 years) were compared with those of a control group of 25 younger patients with a mean age of 42.3 years (range 17–50 years) who underwent MVDs during the same 30-month period from July 2000 to December 2003. Results Initial pain relief was achieved in 96% of the patients in both groups (p = 1.0). There were no operative deaths in either group. After an average follow-up period of 44 and 52 months, 78 and 72% of patients in the elderly and control groups, respectively, remained pain free without medication (p = 0.74). Conclusions Microvascular decompression is an effective treatment for elderly patients with TN. The authors' experience suggests that the rate of complications and death after MVD for TN in elderly patients is no different from the rate in younger patients.

Hemifacial Spasm: Comparison of Results between Patients Older and Younger than 70 Years Operated on with Microvascular Decompression

2021 ◽  
Author(s):  
Hua Zhao ◽  
Jin Zhu ◽  
Yin-da Tang ◽  
Lin Shen ◽  
Shi-ting Li
Keyword(s):  
Elderly Patients ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Facial Palsy ◽  
The Elderly ◽  
Elderly Group ◽  
Effective Treatment Option ◽  
Younger Patients ◽  
Significant Difference ◽  
Csf Leakage

Abstract Objective The aim of the present study was to evaluate the efficacy and safety of microvascular decompression (MVD) for primary hemifacial spasm (HFS) in patients aged ≥70 years and to compare the outcome with a control cohort of younger patients(<70 years). Methods In this retrospective study, subjects were divided into two groups: an elderly group (patients who were ≥70 years) and a younger group. We compared demographic and clinical data, surgical outcome, MVD-related complications, and duration of operation and hospitalization after MVD between the two groups. Results At a mean follow-up of 32 ± 4.2 months, 188 elderly patients (90.4%) reported an effective outcome without need for any medication versus 379 (91.1%) of the younger cohort. There was no mortality in both cohorts. The prevalence of delayed facial palsy was 4.8% in the elderly group and 4.1% in the younger group. One (0.5%) patient in the elderly group and 3 (0.7%) patients in the younger group suffered cerebrospinal fluid (CSF) leakage. There was no significant difference between the two groups in terms of MVD-related complications, such as delayed facial palsy, hearing impairment, CSF leakage, and hematoma. Conclusions MVD is an effective treatment option in elderly patients with HFS as well as in younger patients. Age itself seems to be no relevant contraindication or, alternatively, risk factor regarding MVD.

Microvascular decompression for elderly patients with trigeminal neuralgia: a prospective study and systematic review with meta-analysis

2011 ◽  
Vol 114 (1) ◽  
pp. 172-179 ◽  
Author(s):  
Raymond F. Sekula ◽  
Andrew M. Frederickson ◽  
Peter J. Jannetta ◽  
Matthew R. Quigley ◽  
Khaled M. Aziz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Prospective Study ◽  
Microvascular Decompression ◽  
Cranial Nerve ◽  
Meta Analysis ◽  
Complication Rates ◽  
Significant Difference

Object Because the incidence of trigeminal neuralgia (TN) increases with age, neurosurgeons frequently encounter elderly patients with this disorder. Although microvascular decompression (MVD) is the only etiological therapy for TN with the highest initial efficacy and durability of all treatments, it is nonetheless associated with special risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the commonly performed ablative procedures. Thus, the safety of MVD in the elderly remains a concern. This prospective study and systematic review with meta-analysis was conducted to determine whether MVD is a safe and effective treatment in elderly patients with TN. Methods In this prospectively conducted analysis, 36 elderly patients (mean age 73.0 ± 5.9 years) and 53 nonelderly patients (mean age 52.9 ± 8.8 years) underwent MVD over the study period. Outcome and complication data were recorded. The authors also conducted a systematic review of the English literature published before December 2009 and providing outcomes and complications of MVD in patients with TN above the age of 60 years. Pooled complication rates of stroke, death, cerebellar hematoma, and permanent cranial nerve deficits were analyzed. Results Thirty-one elderly patients (86.1%) reported an excellent outcome after MVD (mean follow-up 20.0 ± 7.0 months). Twenty-five elderly patients with Type 1 TN were compared with 26 nonelderly patients with Type 1 TN, and no significant difference in outcomes was found (p = 0.046). Three elderly patients with Type 2a TN were compared with 12 nonelderly patients with Type 2a TN, and no significant difference in outcomes was noted (p = 1.0). Eight elderly patients with Type 2b TN were compared with 15 nonelderly patients with Type 2b TN, and no significant difference in outcomes was noted (p = 0.086). The median length of stay between cohorts was compared, and no significant difference was noted (2 days for each cohort, p = 0.33). There were no CSF leaks, no cerebellar hematomas, no strokes, and no deaths. Eight studies (1334 patients) met the inclusion criteria for the meta-analysis. For none of the complications was the incidence significantly more frequent in elderly patients than in the nonelderly. Conclusions Although patient selection remains important, the authors' experience and the results of this systematic review with meta-analysis suggest that the majority of elderly patients with TN can safely undergo MVD.

PS01.162: IS THERE A DIFFERENCE IN SURVIVAL BETWEEN YOUNGER AND OLDER GASTRIC CANCER (INCLUDING AEG II AND AEG III) PATIENTS AFTER GASTRECTOMY?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 95-95
Author(s):  
Benjamin Babic ◽  
Florian Matthias Corvinus ◽  
Edin Hadjijusufovic ◽  
Evangelos Tagkalos ◽  
Hauke Lang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Elderly Patients ◽  
Conflicts Of Interest ◽  
Subtotal Gastrectomy ◽  
Young Patients ◽  
Western World ◽  
Old Patients ◽  
Younger Patients ◽  
Significant Difference

Abstract Background The incidence of gastric cancer decreases in the western world, however, it remains one of the most common diseases (1). There is just little data from Europe comparing the outcome of young and elderly gastric cancer patients. This study compares, depending on the age of 266 patients, the outcome of 266 consecutive gastrectomy cases due to gastric cancer Methods 266 consecutive patients with gastric cancer received a gastrectomy between 2008–2016 at our comprehensive cancer centre. The mean age of the patients in this study was 64 years old (21- 93 years). All patients were followed up regarding survival. The patients were separated in 6 different groups, depending on the age at the time of operation. The different groups were re-analysed and compared to each other regarding median and 5-year survival. Results In this collective the 5-year survival rate for all patients was 43%. There were more diffuse type adenocarcinomas in Patients < 40 years. In younger patients the tumour was staged in an advanced stadium compared to the elderly patients group. There is a significantly higher 5-year survival rate for younger patients after gastrectomy. There is no significant difference, when separating patient groups in to decades of age. Conclusion Young patients have a higher 5-year survival rate after gastrectomy compared to old patients. However, comparing patients from chronologic age in decades, the significance is not reproducible. Therefore gastrectomy or subtotal gastrectomy is the determining therapeutic approach for gastric cancer with an acceptable outcome in both young and elderly patients. Older patients might have an lower 5 year survival rate not only due to the cancer or the surgical therapy itself, it is related to comorbidities and a lower rate in neoadjuvant therapy as well Disclosure All authors have declared no conflicts of interest.

MICROVASCULAR DECOMPRESSION FOR TRIGEMINAL NEURALGIA IN THE ELDERLY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 477-482 ◽  
Author(s):  
Thomas Günther ◽  
Venelin M. Gerganov ◽  
Lennart Stieglitz ◽  
Wolf Ludemann ◽  
Amir Samii ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
The Elderly ◽  
Safe Procedure ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Younger Patients ◽  
The Mean

Abstract OBJECTIVE Multiple studies have proved that microvascular decompression (MVD) is the treatment of choice in cases of medically refractory trigeminal neuralgia (TN). In the elderly, however, the surgical risks related to MVD are assumed to be unacceptably high and various alternative therapies have been proposed. We evaluated the outcomes of MVD in patients aged older than 65 years of age and compared them with the outcomes in a matched group of younger patients. The focus was on procedure-related morbidity rate and long-term outcome. METHODS This was a retrospective study of 112 patients with TN operated on consecutively over 22 years. The main outcome measures were immediate and long-term postoperative pain relief and neurological status, especially function of trigeminal, facial, and cochlear nerves, as well as surgical complications. A questionnaire was used to assess long-term outcome: pain relief, duration of a pain-free period, need for pain medications, time to recurrence, pain severity, and need for additional treatment. RESULTS The mean age was 70.35 years. The second and third branches of the trigeminal nerve were most frequently affected (37.3%). The mean follow-up period was 90 months (range, 48–295 months). Seventy-five percent of the patients were completely pain free, 11% were never pain free, and 14% experienced recurrences. No statistically significant differences existed in the outcome between the younger and older patient groups. Postoperative morbidity included trigeminal hypesthesia in 6.25%, hypacusis in 5.4%, and complete hearing loss, vertigo, and partial facial nerve palsy in 0.89% each. Cerebrospinal fluid leak and meningitis occurred in 1 patient each. There were no mortalities in both groups. CONCLUSION MVD for TN is a safe procedure even in the elderly. The risk of serious morbidity or mortality is similar to that in younger patients. Furthermore, no significant differences in short- and long-term outcome were found. Thus, MVD is the treatment of choice in patients with medically refractory TN, unless their general condition prohibits it.

Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas

2015 ◽  
Vol 123 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Jackson A. Gondim ◽  
João Paulo Almeida ◽  
Lucas Alverne F. de Albuquerque ◽  
Erika Gomes ◽  
Michele Schops ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Transsphenoidal Surgery ◽  
Clinical Status ◽  
The Elderly ◽  
Elderly Group ◽  
Complication Rates ◽  
Endoscopic Transsphenoidal Surgery ◽  
Younger Patients ◽  
Significant Difference

OBJECT With the increase in the average life expectancy, medical care of elderly patients with symptomatic pituitary adenoma (PA) will continue to grow. Little information exists in the literature about the surgical treatment of these patients. The aim of this study was to present the results of a single pituitary center in the surgical treatment of PAs in patients > 70 years of age. METHODS In this retrospective study, 55 consecutive elderly patients (age ≥ 70 years) with nonfunctioning PAs underwent endoscopic transsphenoidal surgery at the General Hospital of Fortaleza, Brazil, between May 2000 and December 2012. The clinical and radiological results in this group were compared with 2 groups of younger patients: < 60 years (n = 289) and 60–69 years old (n = 30). RESULTS Fifty-five patients ≥ 70 years of age (average age 72.5 years, range 70–84 years) underwent endoscopic surgery for treatment of PAs. The mean follow-up period was 50 months (range 12–144 months). The most common symptoms were visual impairment in 38 (69%) patients, headache in 16 (29%) patients, and complete ophthalmoplegia in 6 (10.9%). Elderly patients presented a higher incidence of ophthalmoplegia (p = 0.032) and a lower frequency of pituitary apoplexy before surgery (p < 0.05). Tumors with cavernous sinus invasion were treated surgically less frequently than in younger patients. Although patients with an American Society of Anesthesiologists score of 3 were more common in the elderly group (p < 0.05), no significant difference regarding surgical time, extent of resection, and hospitalization were observed. Elderly patients presented with more complications than patients < 60 years (32.7% vs 10%, p < 0.05). Complications observed in the elderly group included 5 CSF leaks (9%), 2 permanent diabetes insipidus cases (3.6%), 4 postoperative refractory hypertension cases (7.2%), 1 myocardial ischemia (1.8%), and 1 death (1.8%). Postoperative new anterior pituitary deficit was more common in the younger group (< 60 years old: 17.7%) than in the elderly (≥ 70 years old: 12.7%); however, there was no statistical difference. CONCLUSIONS Endoscopic transsphenoidal surgery for elderly patients with PAs may be associated with higher complication rates, especially secondary to early transitory complications, when compared with surgery performed in younger patients. Although the worst preoperative clinical status might be observed in this group, age alone is not associated with a worst final prognosis after endoscopic removal of nonfunctioning PAs.

P1353IS AGE RISK FACTOR FOR TUNNELED VASCULAR CATHETER OUTCOMES?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Sanja Bajcetic ◽  
Aleksandar Jankovic ◽  
Petar Djuric ◽  
Bojan Stopić ◽  
Radomir Naumovic ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Elderly Patients ◽  
Statistical Significance ◽  
Treatment Options ◽  
The Elderly ◽  
Related Complication ◽  
Primary Position ◽  
Exit Site Infection ◽  
Younger Patients ◽  
Significant Difference

Abstract Background and Aims According to previous data, the prevalence of tunnelled cuffed vascular catheters (TCC) is more frequent in elderly as compared to younger HD patients. Still, it is not clear if elderly have decreased survival of TCC as compared with survival in younger. Method During the period from January 2010 to June 30, 2015, 110 permanent catheters were implanted in 64 patients (1.72 catheters per patient, 51.6% male mean age 67±12years, 20 diabetics). Out of all patients, 44 (68.7%) were older than 65 years, 12 (27.3%) were diabetic and 11 (25%) were previously treated with peritoneal dialysis. In the age-based subpopulations we compared the incidence of infections, thrombosis, chemical removal of thrombus by actilysis and TCC outcome. Results Reasons for TCC placement in elderly were inability of the second option and exhausted vascular approach and these reasons were found to be significantly more frequent compared to patients younger than 65 years (p = 0.020 ). Primary position of TCC was right jugular vein in both groups (39.1%, No = 25 vs 14.1% No = 9), more commonly in group of elderly patients, but there was no significant difference in the initial TCC position depending on the age structure of the patient (Hi square = 1.720, p = 0.886). The overall incidence of infections was 3.44 episodes per 1000 catheter days and patients' age did not affect TCC replacement, infection, thrombosis and inflammation. In the group of elderly, 27 patients had catheter infection (61.4%), 10 (22.7%) had catheter thrombosis and actilysis resolved thrombosis in 6 (13.6%) patients without significant difference as compared with younger patients. Catheter-induced bacteraemia were more common in TCC over 65 years (47 TCC vs. 12 TCC) but without statistical significance (p = 0.062). Similarly, exit site infection, was more common (14 TCC vs. 4 TCC) for those older than 65 years but also without statistical significance. Thrombosis of TCC occurred in 7 patients with TCC younger than 65 years and in 20 TCC in cohort of elderly (Hi square = 0.033, p = 0.535) (Table 1). Regarding treatment outcome, 19 (43.2%) elderly patients died while being treated with TCC, 12 patients (27.3%) changed treatment modality to peritoneal dialysis, 4 patients (9.1%) received arteriovenosus graft (AVG) and 9 patients had functional TCC at the end of follow up (20.5%) and no significant difference was found in the outcome compared to younger patients. Conclusion The reason for placement of TCC in elderly is the inability of other treatment options and exhaustion of vascular access. Concerning catheter related complication and outcome, there was no significant difference between the elderly and younger patient.

scholarly journals Outcomes of endoscopic submucosal dissection for superficial esophageal cancer in an elderly population: a retrospective single center cohort study

2019 ◽  
Vol 07 (03) ◽  
pp. E355-E360 ◽  
Author(s):  
Toshiro Iizuka ◽  
Daisuke Kikuchi ◽  
Shu Hoteya
Keyword(s):  
Esophageal Cancer ◽  
Elderly Patients ◽  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
The Elderly ◽  
Superficial Esophageal Cancer ◽  
Younger Patients ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is increasingly being used to treat superficial esophageal cancer in the elderly. However, data on clinical outcomes in this age group are limited. The aim of this study was to evaluate the safety and efficacy of ESD in treatment of superficial esophageal cancer and its effect on long-term outcome in the elderly. Patients and methods In total, 664 consecutive patients with a histological diagnosis of squamous cell carcinoma or high-grade intraepithelial neoplasia who underwent ESD between April 2008 and March 2016 at our institution were enrolled. Clinical outcomes and prognostic factors were compared retrospectively between those aged 75 years or older (n = 162) and those aged younger than 75 years (n = 502). Results There was no significant difference in post-ESD bleeding (0 vs. 0.8 %, P = 0.27) and perforation rates (1.8 vs. 1.2 %, P = 0.47) between the two age groups; however, stricture rate was higher in younger patients than in elderly patients (20.8 % vs 11 %; P = 0.036). There was no significant difference in the rate of locoregional recurrence between the two groups. Overall survival was significantly different between the two groups, but cause-specific survival was similar. Conclusion These findings confirm the efficacy of ESD for superficial esophageal cancer in selected elderly patients (75 years or older) who were fit for the treatment because they can achieve similar long-term survival to younger patients.

scholarly journals Elderly Patients with Metastatic Neuroendocrine Tumors Are Undertreated and Have Shorter Survival: The LyREMeNET Study

2019 ◽  
Vol 110 (7-8) ◽  
pp. 653-661 ◽  
Author(s):  
Annie Lemelin ◽  
Delphine Maucort-Boulch ◽  
Elisabeth Castel-Kremer ◽  
Julien Forestier ◽  
Valérie Hervieu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Neuroendocrine Tumors ◽  
Real Life ◽  
Peptide Receptor Radionuclide Therapy ◽  
Tumor Grade ◽  
The Elderly ◽  
Younger Patients ◽  
Poorly Differentiated Neuroendocrine Carcinoma ◽  
Significant Difference

Introduction: The incidence of neuroendocrine tumors (NETs) is rising, especially in elderly patients. The elderly cancer population presents considerable challenges, yet little is known about the characteristics, treatment patterns, and outcomes of metastatic NET (mNET) patients. Methods: The Lyon Real-life Evidence in Metastatic NeuroEndocrine Tumors study (LyREMeNET, NCT03863106) included consecutive mNET patients, diagnosed between January 1990 and December 2017. The exclusion criteria were nonmetastatic NET, poorly differentiated neuroendocrine carcinoma, and mixed neuroendocrine-nonneuroendocrine neoplasms. We aimed to compare patients ≥70 years old to patients <70 years old. Results: A total of 866 patients were included, 198 (23%) were ≥70 years old. There was no significant difference in characteristics except that elderly patients had synchronous metastasis more frequently. Elderly patients received significantly fewer treatments (median of 2.0 vs. 3.0 lines, respectively, p < 0.0001), were significantly less frequently treated by chemotherapy (32 vs. 54%), targeted therapy (16 vs. 30%), peptide receptor radionuclide therapy (5 vs. 16%), and they underwent significantly less frequently locoregional intervention. Median overall survival was significantly shorter in elderly patients (5.2 vs. 9.6 years). The most frequent cause of death was related to disease progression (71%). Multivariate analysis found that, after adjustment for tumor location, tumor grade, and number of metastatic sites, age remained significantly associated with overall survival (HR 1.66, 95% CI 1.26–2.18), indicating a poorer survival in patients ≥70 years old in comparison with younger patients (p = 0.0003). Conclusion: Patients ≥70 years old have a worse survival, die frequently from their disease, and are undertreated compared to younger patients.

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