scholarly journals Thyroid cancer surgery in the elderly: a comparative study of 1176 patients

2018 ◽  
Vol 5 (6) ◽  
pp. 2000
Author(s):  
Omer Parlak ◽  
Fatma Dilek Dellal ◽  
Serap Ulusoy ◽  
Ibrahim Kılınc
Keyword(s):  
Thyroid Cancer ◽  
Elderly Patients ◽  
Geriatric Patients ◽  
The Elderly ◽  
Cancer Surgery ◽  
Cancer Type ◽  
Capsular Invasion ◽  
Significant Difference ◽  
Surgery In The Elderly ◽  
Male Patients

Background: The aim of this study is to compare the results of patients who were treated with two groups (under 65 years and over 65 years) of thyroid cancer.Methods: A retrospective review of 1176 patients undergoing thyroid cancer surgery between January 2007 and December 2016 was performed. Patients were grouped as ≥65 (geriatric group) and <65 years (non-geriatric group).Results: A total of 139 patients (11.8%) were over 65 years of age and 1037 patients (88.2%) were under 65 years of age. There were 104 female (74.8%) and 35 (25.2%) male patients in the geriatric group. In the non-geriatric group, 917 (78%) patients were female and 259 (22%) were male (p = 0.39). FNAB showed a significant increase in malignant potential in the elderly (p = 0.005). In our series, malignant differences between geriatric and non-geriatric groups are less pronounced among thyroid carcinomas other than capsular invasion. Although there was no significant difference in histopathologic examination, malignant cytology was higher in the elderly patients. There was no significant difference between the young and elderly patients in terms of complication.Conclusions: In this study, papillary Thyroid Ca (PTC) was found to be the most common type of cancer and we could not find any difference in cancer type distribution in geriatric and non-geriatric patients. Total/near total thyroidectomy in experienced hands is safe for elderly patients. There is no difference in terms of complication.

scholarly journals Cancer Surgery in the Elderly

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Gopal C. Kowdley ◽  
Nishant Merchant ◽  
James P. Richardson ◽  
Justin Somerville ◽  
Myriam Gorospe ◽  
...  
Keyword(s):  
Decision Making ◽  
Elderly Patients ◽  
The Elderly ◽  
Cancer Surgery ◽  
Decision Making Process ◽  
Benefit Ratio ◽  
Patients With Cancer ◽  
The World ◽  
Surgery In The Elderly ◽  
Surgical Treatments

The proportions both of elderly patients in the world and of elderly patients with cancer are both increasing. In the evaluation of these patients, physiologic age, and not chronologic age, should be carefully considered in the decision-making process prior to both cancer screening and cancer treatment in an effort to avoid ageism. Many tools exist to help the practitioner determine the physiologic age of the patient, which allows for more appropriate and more individualized risk stratification, both in the pre- and postoperative periods as patients are evaluated for surgical treatments and monitored for surgical complications, respectively. During and after operations in the oncogeriatric populations, physiologic changes occuring that accompany aging include impaired stress response, increased senescence, and decreased immunity, all three of which impact the risk/benefit ratio associated with cancer surgery in the elderly.

scholarly journals Angioplasty Outcomes in the Elderly Nepalese Patients: an eight years experience in Norvic International Hospital

2013 ◽  
Vol 8 (1) ◽  
pp. 27-29
Author(s):  
G Chirag ◽  
B Rawat ◽  
S Rajbhandari ◽  
Y Bhatta ◽  
JP Jaiswal ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Age Groups ◽  
The Elderly ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Hospital Death ◽  
Interventional Treatment ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Male Patients ◽  
Transluminal Coronary Angioplasty

Background The aim of the study is to evaluate and compare the outcomes of percutaneous transluminal coronary angioplasty (PTCA) between the elderly (>70 yrs) and the non-elderly (70 yrs and younger) Nepalese patients who had been admitted to Norvic International Hospital between early 2002 and April 2010. Methods Data of a total of 92 elderly and 604 non-elderly patients were retrospectively analyzed after they had been admitted in the Hospital for the interventional treatment of acute coronary syndrome. Results There were 64 (69.6%) male patients and 28 (30.4%) female patients in the elderly group. Elderly population had lesser smokers. Diabetic population was similar in both the age groups. The elderly patients slightly less success rate compared to the non-elderly (95.7% vs. 99.3%). There was no significant difference in bleeding complication and groin haematoma. In hospital death was 3.33% in elderly and 0.5% in non elderly. Conclusion Though the outcome in the elderly is poorer in comparison to the younger patients, it is an expected result when compared to even the biggest centres worldwide. DOI: http://dx.doi.org/10.3126/njh.v8i1.8334 Nepalese Heart Journal Vol.8(1) 2011 pp.27-29

scholarly journals Outcome of Colonic Surgery in Elderly Patients with Colon Cancer

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
E. Hermans ◽  
P. M. van Schaik ◽  
H. A. Prins ◽  
M. F. Ernst ◽  
P. J. L. Dautzenberg ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Elderly Patients ◽  
Operative Mortality ◽  
Survival Rates ◽  
The Elderly ◽  
Colonic Surgery ◽  
Cardiovascular Pathology ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Surgery In The Elderly

Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older.Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients.Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years.Results. Elderly patients presented significantly more (P<.05) as a surgical emergency, had a longer duration of admission and were more often admitted to the ICU (P<.01). Also, elderly patients had significant more co-morbidities, especially cardiovascular pathology (P<.01). Post-operative complications were seen more often in the elderly, although no significant difference was seen in anastomotic leakage. The five-year survival rate in the younger group was 62% compared with 36% in the elderly (P<.05). DFS was 61% in the younger patients compared with 32% in the elderly (P<.05).Conclusion. Curative resection of colonic carcinoma in the elderly is well tolerated and age alone should not be an indication for less aggressive therapy. However, the type and number of co-morbidities influence post-operative mortality and morbidity.

scholarly journals Endonasal endoscopic pituitary surgery in the elderly

2018 ◽  
Vol 128 (2) ◽  
pp. 429-436 ◽  
Author(s):  
Peter J. Wilson ◽  
Sacit B. Omay ◽  
Ashutosh Kacker ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Elderly Patients ◽  
Complication Rate ◽  
Pituitary Adenomas ◽  
Statistical Tests ◽  
The Elderly ◽  
Medical Complications ◽  
Tumor Diameter ◽  
Complication Rates ◽  
Pseudoaneurysm Formation ◽  
Significant Difference

OBJECTIVEPituitary adenomas are benign, slow-growing tumors that cause symptoms either through mass effect or hormone overproduction. The decision to operate on a healthy young person is relatively straightforward. In the elderly population, however, the risks of complications may increase, rendering the decision more complex. Few studies have documented the risks of surgery using the endonasal endoscopic approach in a large number of elderly patients. The purpose of this study was to audit a single center's data regarding outcomes of purely endoscopic endonasal transsphenoidal resection of pituitary adenomas in elderly patients and to compare them to the current literature.METHODSA retrospective review of a prospectively acquired database of all endonasal endoscopic surgeries done by the senior authors was queried for patients aged 60–69 years and for those aged 70 years or older. Demographic and radiographic preoperative data were reviewed. Outcomes with respect to extent of resection and complications were examined and compared with appropriate statistical tests.RESULTSA total of 135 patents were identified (81 aged 60–69 years and 54 aged 70 years or older [70+]). The average tumor diameter was slightly larger for the patients in the 70+ age group (mean [SD] 25.7 ± 9.2 mm) than for patients aged 60–69 years (23.1 ± 9.8 mm, p = 0.056). There was no significant difference in intraoperative blood loss (p > 0.99), length of stay (p = 0.22), or duration of follow-up (p = 0.21) between the 2 groups. There was a 7.4% complication rate in patients aged 60–69 years (3 nasal and 3 medical complications) and an 18.5% complication rate in patients older than 70 years (4 cranial, 3 nasal, 1 visual, and 2 medical complications; p = 0.05 overall and 0.013 for cranial complications). Cranial complications in the 70+ age category included 2 postoperative hematomas, 1 pseudoaneurysm formation, and 1 case of symptomatic subdural hygromas.CONCLUSIONSEndonasal endoscopic surgery in elderly patients is safe, but there is a graded increase in complication rates with increasing age. The decision to operate on an asymptomatic or mildly symptomatic patient in these age groups should take this increasing complication rate into account. The use of a lumbar drain or lumbar punctures should be weighed against the risk of subdural hematoma in patients with preexisting atrophy.

Two Types of Anesthesia and Hemodynamic Changes in Patients Over 60 Years of Age Who Need Artificial Femoral Head Replacement: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Weiqi Ke ◽  
Yuting WANG ◽  
Xukeng GUO ◽  
Ronghua HUANG ◽  
Xiangdong ZHANG ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Femoral Head ◽  
Elderly Patients ◽  
The Elderly ◽  
Hemodynamic Changes ◽  
Medical College ◽  
Replacement Surgery ◽  
Elder Patients ◽  
Significant Difference ◽  
And Gender

Abstract Background:Artificial femoral head replacement is one of the most effective methods for treatment of severe diseases of femoral joint in the elderly. The ideal anesthetic effect is one of the key elements for the success of the operation because it brings fast recovery. However, the multiple comorbidities of the elder patients make them too weak to tolerate the hemodynamic changes after anesthesia. In this case, the most suitable anesthesia method for patients undergoing femoral head replacement surgery is of great significance.Objective:To compare the post-anesthetic hemodynamic changes between combined lumbar plexus and sciatic nerve block(CLPSB) and combined spinal and epidural anesthesia(CSEA) in elderly patients undergoing unilateral artificial femoral head replacement.Methods:We reviewed records of the patients who aged over 60 years old (age 62-103 years) and received unilateral artificial femoral head replacement between January 2015 and December 2020 in the first affiliated hospital of Shantou University Medical College. After adjustment according to the inclusion criteria, 477 patients were included and divided into CLPSB group (n=90) and CSEA group (n=387). The primary outcome was comparison of the hemodynamic changes after anesthesia, including the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). The second outcome was the comparison of the vasopressor used during the surgery.Results:We established three models to compare the two anesthesia methods on hemodynamic changes. Crude model included all variates for analysis, while model I adjusted age and gender. Model II adjusted other comorbidities in addition to model I. All three models exhibit that changes of MAP (∆MAP) after CSEA were higher than that after CLPSB(β= 6.88, 95% CI: 4.33 - 9.42, P < 0.0001), with significant difference, which indicated that CSEA causes higher fluctuation of MAP. Concurrently, the use of vasopressors increased by 137% (OR=2.37, 95%CI: 1.24-4.53, P=0.0091) in the CSEA group, which is statistically significant. However, the changes of HR (∆HR) between the CLPSB and CSEA was not significant(β= 0.50, 95% CI: 1.62 - 2.62, P = 0.6427). Conclusions:Both CLPSB and CSEA are ideal anesthesia methods for patients receiving femoral head eplacement, though CLPSB is more suitable for elderly patients with advanced hemodynamic stability.

Colorectal cancer surgery in the elderly: acceptable morbidity?

2008 ◽  
Vol 195 (3) ◽  
pp. 344-348 ◽  
Author(s):  
Evan S. Ong ◽  
Mohamed Alassas ◽  
Kelli Bullard Dunn ◽  
Ashwani Rajput
Keyword(s):  
Colorectal Cancer ◽  
The Elderly ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Surgery In The Elderly

Rectal cancer surgery in the elderly: analysis of consecutive 158 patients with stage III rectal cancer

2007 ◽  
Vol 392 (5) ◽  
pp. 549-558 ◽  
Author(s):  
Tsukasa Hotta ◽  
Katsunari Takifuji ◽  
Shozo Yokoyama ◽  
Kenji Matsuda ◽  
Takashi Higashiguchi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
The Elderly ◽  
Cancer Surgery ◽  
Stage Iii ◽  
Rectal Cancer Surgery ◽  
Surgery In The Elderly

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.

scholarly journals Multicenter phase III randomized trial comparing laparoscopy and laparotomy for colon cancer surgery in patients older than 75 years: the CELL study, a Fédération de Recherche en Chirurgie (FRENCH) trial

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gilles Manceau ◽  
Antoine Brouquet ◽  
Pascal Chaibi ◽  
Guillaume Passot ◽  
Olivier Bouché ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Elderly Patients ◽  
Randomized Trial ◽  
Postoperative Morbidity ◽  
The Elderly ◽  
Cancer Surgery ◽  
Phase Iii ◽  
Randomized Controlled ◽  
Colon Cancer Surgery

Abstract Background Several multicenter randomized controlled trials comparing laparoscopy and conventional open surgery for colon cancer have demonstrated that laparoscopic approach achieved the same oncological results while improving significantly early postoperative outcomes. These trials included few elderly patients, with a median age not exceeding 71 years. However, colon cancer is a disease of the elderly. More than 65% of patients operated on for colon cancer belong to this age group, and this proportion may become more pronounced in the coming years. In current practice, laparoscopy is underused in this population. Methods The CELL (Colectomy for cancer in the Elderly by Laparoscopy or Laparotomy) trial is a multicenter, open-label randomized, 2-arm phase III superiority trial. Patients aged 75 years or older with uncomplicated colonic adenocarcinoma or endoscopically unresectable colonic polyp will be randomized to either colectomy by laparoscopy or laparotomy. The primary endpoint of the study is overall postoperative morbidity, defined as any complication classification occurring up to 30 days after surgery. The secondary endpoints are: 30-day and 90-day postoperative mortality, 30-day readmission rate, quality of surgical resection, health-related quality of life and evolution of geriatric assessment. A 35 to 20% overall postoperative morbidity rate reduction is expected for patients operated on by laparoscopy compared with those who underwent surgery by laparotomy. With a two-sided α risk of 5% and a power of 80% (β = 0.20), 276 patients will be required in total. Discussion To date, no dedicated randomized controlled trial has been conducted to evaluate morbidity after colon cancer surgery by laparoscopy or laparotomy in the elderly and the benefits of laparoscopy is still debated in this context. Thus, a prospective multicenter randomized trial evaluating postoperative outcomes specifically in elderly patients operated on for colon cancer by laparoscopy or laparotomy with curative intent is warranted. If significant, such a study might change the current surgical practices and allow a significant improvement in the surgical management of this population, which will be the vast majority of patients treated for colon cancer in the coming years. Trial registration ClinicalTrials.gov NCT03033719 (January 27, 2017).

scholarly journals A Comprehensive Overview of Polypharmacy in Elderly Patients in Saudi Arabia

Geriatrics ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 36 ◽  
Author(s):  
Aseel Alsuwaidan ◽  
Norah Almedlej ◽  
Sawsan Alsabti ◽  
Omamah Daftardar ◽  
Fawzi Al Deaji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Adverse Drug Reaction ◽  
Saudi Arabia ◽  
Drug Reaction ◽  
Elderly Patients ◽  
Care Management ◽  
Geriatric Patients ◽  
Health Care Management ◽  
Significant Difference

Background/Objectives: Saudi Arabia has a great percentage of geriatric patients associated with multiple chronic diseases who require close attention and monitoring for their medications. The purpose of this study is to develop a full-framed picture about the utilization of medications for geriatric patients and how to provide better health-care management. Methodology: A retrospective cross-sectional study targeting patients 65 years of age and older, who are taking multiple chronic medications for different indications. Descriptive analysis and frequency of the main variables were used as appropriate. Only qualified and professional candidates were chosen for data entry to present the quality and accuracy of data. Results: A total of 3009 patient profiles were analyzed, with the patients’ average age in years being 73.26 ± 6.6 (SD). It was found that 55% of the patients have polypharmacy. An average of 6.4 medications were prescribed for patients aged between 65 and 70 years compared with a significant difference for patients aged 71 years and above, while a linear correlation between age and comorbidity diseases associated with all elderly patients. Hypertension, hyperlipidemia, and diabetes mellitus are the most common comorbidity diseases for elderly patients aged 65 years and older. Conclusion: Polypharmacy in geriatrics is defined as a patient aged 65 years and older receiving five or more appropriate medications. It is the responsibility of health-care professionals to reduce the number of medications in elderly patients. Awareness of geriatric medications and diagnosed diseases will improve managing adverse drug reaction and other risk factors. Awareness of geriatric medications should elaborate on how to avoid adverse drug reaction and other risk factors. It is the responsibility of physicians and pharmacists to reduce the number of medications in elderly patients. We also prove that the number of medications will not necessarily increase with age. The main impact of this study is to follow the main recommendations to improve health care management in geriatrics.

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