Aspekte operativer Therapie gastrointestinaler Karzinome beim alten Patienten

Schlag, P. M.; Gretschel, Stephan; Moesta, T.; Ulmer, C.; Benhidjeb, Tahar; Slisow, W.

doi:10.1007/s00761-001-0280-x

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…The analysis of the demographic data showed a multivariate significant influence of the age of the patients of ≥75 years on the overall and medical morbidity. Especially in elderly patients, increased peri- and postoperative complications must be expected due to a limitation of the physiological reserve, and a higher incidence of comorbidities, irrespective of the underlying oncological disease [ 4 ]. The results of the present study confirm that this is also valid for patients who need to undergo palliative colorectal surgery.…”

Section: Discussionmentioning

confidence: 99%

Predictive factors of early outcome after palliative surgery for colorectal carcinoma

Konopke¹,

Schubert²,

Stöltzing³

et al. 2020

Innovative Surgical Sciences

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ObjectivesA significant number of patients with colorectal cancer are presented with various conditions requiring surgery in an oncologically palliative setting. We performed this study to identify risk factors for early outcome after surgery to facilitate the decision-making process for therapy in a palliative disease.MethodsWe performed a retrospective chart review of 142 patients who underwent palliative surgery due to locally advanced, complicated, or advanced metastatic colorectal carcinoma between January 2010 and April 2018 at the “Elbland” Medical Center Riesa. We performed a logistic regression analysis of 43 factors to identify independent predictors for complications and mortality.ResultsSurgery included resections with primary anastomosis (n=31; 21.8%) or discontinuous resections with colostomy (n=38; 26.8%), internal bypasses (n=27; 19.0%) and stoma formation only (n=46; 32.4%). The median length of hospitalization was 12 days (2–53 days), in-hospital morbidity was 50.0% and the mortality rate was 18.3%. Independent risk factors of in-hospital morbidity were age (HR: 1.5, p=0.046) and various comorbidities of the patients [obesity (HR: 1.8, p=0.036), renal failure (HR: 1.6, p=0.040), diabetes (HR: 1.6, p=0.032), alcohol abuse (HR: 1.3, p=0.023)] as well as lung metastases (HR: 1.6, p=0.041). Arteriosclerosis (HR: 1.4; p=0.045) and arterial hypertension (HR: 1.4, p=0.042) were independent risk factors for medical complications in multivariate analysis. None of the analyzed factors predicted the surgical morbidity after the palliative procedures. Emergency surgery (HR: 10.2, p=0.019), intestinal obstruction (HR: 9.2, p=0.006) and ascites (HR: 5.0, p=0.034) were multivariate significant parameters of in-hospital mortality.ConclusionsPalliatively treated patients with colorectal cancer undergoing surgery show high rates of morbidity and mortality after surgery. In this retrospective chart review, independent risk factors for morbidity and in-hospital mortality were identified that are similar to patients in curative care. An adequate selection of patients before palliative operation should lead to a better outcome after surgery. Especially in patients with intestinal obstruction and ascites scheduled for emergency surgery, every effort should be made to convey these patients to elective surgery by interventional therapy, such as a stent or minimally invasive stoma formation.

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Section: Discussionmentioning

confidence: 99%

Predictive factors of early outcome after palliative surgery for colorectal carcinoma

Konopke¹,

Schubert²,

Stöltzing³

et al. 2020

Innovative Surgical Sciences

View full text Add to dashboard Cite

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“…Eine subtile präoperative Diagnostik einschließlich Staging-Untersuchungen zum Primärtu-mor mit gleichzeitiger Therapie und Korrektur etwaiger Risikofaktoren in interdisziplinärer Absprache ist somit von entscheidender Bedeutung, um auch beim alten Patienten mit einem Magenkarzinom eine adäquate und stadiengerechte Chirurgie -unter Umständen zusammen mit einer vorgeschalteten Chemotherapie -mit kalkulierbarem Operationsrisiko durchführen zu können und sich nicht nur auf symptomorientierte palliative Maßnahmen beschränken zu müssen [3,[17][18][19]. [8,10,14,17,19,20,26,28,31].…”

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Chirurgie des Magenkarzinoms – gibt es Grenzen im Alter?

Meyer¹,

Raab²,

Opitz³

2003

Visc Med

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Surgical Treatment of Gastric Carcinoma – Are There Limitations in Elderly Patients? Because of increasing life expectancy, the share of elderly patients with gastric carcinomas will rise in the future even though the incidence is decreasing worldwide. Surgical therapy should fulfill the requirements of surgical oncology in regard to the indication as well as to the extent of intra- and extraluminal resection even in these patients particularly as the pathohistological findings in this patient group were not significantly different from those of younger patients. The calculation of the perioperative risk depends on the biological age. Despite optimal perioperative treatment, relevant comorbidity can lead to increased but justifiable morbidity and mortality. Depending on prevalent symptoms, also in very old patients limited surgical and interventional procedures can be carried out.

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Onkologie: Besonderheiten alter Menschen

Wedding¹,

Höffken²

2003

Visc Med

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Oncology: Characteristics of Elderly Patients The number of elderly patients with cancer will increase substantially within the next decades. These patients are not treated with the same oncological diligence as younger patients. Older patients are less often treated within clinical trials. The available data represent a selected group of patients. Older patients present with a variety of changes, which have to be taken into consideration for decision making. These are 1) reduced live expectation, 2) reduced reserve capacity, 3) changes in pharmacokinetics and pharmacodynamics, 4) co-morbidities, 5) co-medication, and 6) restrictions in functional status. In addition to a thorough examination of the oncological disease, the special situation of the elderly patients should be assessed within a geriatric assessment. It often reflects the true situation of the patients better than the normal clinical examination. This kind of assessment will be important within different decision processes: 1) early detection, 2) need of surgery, 3) need of adjuvant therapy, 4) intensity of chemotherapy, and 5) kind of follow-up. But at this time, evidence from prospective randomized trials that geriatric assessment improves the care for elderly patients with cancer is still missing.

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Aspekte operativer Therapie gastrointestinaler Karzinome beim alten Patienten

Cited by 3 publications

References 13 publications

Predictive factors of early outcome after palliative surgery for colorectal carcinoma

Predictive factors of early outcome after palliative surgery for colorectal carcinoma

Chirurgie des Magenkarzinoms – gibt es Grenzen im Alter?

Onkologie: Besonderheiten alter Menschen

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