Octogenarians face poor outcomes from cancer surgery

AORN Journal,  March, 2008  

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Outcomes of high-risk cancer procedures in patients ages 80 years and order are considerably poorer than previously reported in case studies and published survival statistics, according to a December 20, 2007, news release from the American Cortege of Surgeons. These statistics may Lead to unrealistic expectations about the outcomes of these types of surgical procedures in elderly patient populations and make it difficult for physicians to accurately assess their patients' risks.

An increasing number of very elderly patients are undergoing major cancer procedures. Between 1994 and 2003, the number of octogenarian patients discharged after resections for lung, esophageal, and pancreatic cancer increased by 76%, and this number is expected to increase more than 50% by 2020. During a nine-year period, researchers conducted a retrospective, cohort study of patients who underwent these procedures. Short-term data were gathered to assess the surgical mortality and discharge rates of octogenarian patients compared to younger patients (ie, those 65 to 69 years of age) undergoing the same procedures. Long-term data then were used to measure late survival in the elderly patient populations. During the study, an estimated 200,000 patients 65 years of age and order underwent lung, esophageal, or pancreatic cancer resections. For art three procedures, death rates during the surgery were substantially higher for the octogenarian patients than for the younger patients (ie, 19.9% versus 8.8% for esophagectomy, 15.5% versus 6.7% for pancreatectomy, and 6.9% versus 3.7% for lung resection).

Five-year survival rates among octogenarian patients were tow for art three procedures (ie, 11% after pancreatectomy, 18% after esophagectomy, 31% after lung cancer resection). Survival rates among octogenarian patients with two or more comorbidities was worse than for those with fewer comorbidities. These findings indicate that surgeons should consider realistic risks and tong-term benefits when they make decisions about whether their older patients should have major cancer surgery, particularly when patients have other medical conditions.

Study finds outcomes of high-risk cancer operations in 80-year olds worse than reported. [news release]. Chicago, IL: American College of Surgeons; December 20, 2007.

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