Surgical Considerations in the Older Adult With Lung Cancer
There is the question regarding the extent of surgery, including lobectomy versus sublobar resection in elderly patients with lung cancer and whether less surgery has acceptable pulmonary and oncologic outcomes. These different approaches are currently being studied. In patients undergoing thoracic surgery, a geriatric preoperative assessment using measures designed to define increased risk of postoperative complications was able to predict both risk of postoperative institutionalization and 6-month survival.1
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Surgical Considerations in the Older Adult With Colorectal Cancer
There are models for predicting postoperative morbidity and mortality in the general population such as POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) and Elderly POSSUM.
There have been no statistically significant differences based on age for postoperative complications using a laparoscopic approach versus an open approach. Because of the complexity of multimodal care for patients with rectal cancer, this is a unique patient group where it is very important to assure that the patient has enough surgical support in the perioperative period. In a 2-year follow-up of patients with rectal cancer who underwent surgery, it was shown that physical and role functioning of patients older than age 70 years may never reach baseline.1
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Surgical Considerations in the Older Adult With Hepatobiliary Cancer
For patients undergoing pancreatectomy, one large series demonstrated that age was not an independent risk factor for perioperative morbidity and mortality. In a statewide report out of Texas that evaluated outcomes of patients undergoing pancreatectomy, age was found to be an independent predictor for need for discharge to an inpatient nursing facility and an increase in inhospital mortality (4.5-fold higher risk). As in other studies, high volume centers had a lower morbidity and mortality in elderly patients.1
Surgical Considerations in the Older Adult With Head and Neck Cancer
“The goal is to maximize oncologic control with minimal impact on function, form and quality of life.” Additional challenges exist related to speech impairment, tracheostomy, and need for enteral feeding which should be addressed in depth prior to resection.
“Successful surgical treatment of the elderly patient therefore depends on a proactive, patient-centric, multidisciplinary program that involves a geriatrician and in which all stakeholders are committed to understanding the unique needs and expectations of the patients and their family.”1
The review from Korc-Grodzicki and colleagues details many considerations in elderly patients who are eligible for surgical management of their cancer. It is my opinion that a tailored approach and consideration of the patients’ cancer along with psychosocial, economic, and emotional support need to be addressed through a formal team approach and risk assessment before undertaking major oncologic surgery in this select group of patients.
Reference
- Korc-Grodzicki B, Downey RJ, Shahrokni A, et al. Surgical considerations in older adults with cancer. J Clin Oncol. 2014;32(24):2647-2653.
