Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model

Abstract

The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological surgery in elderly patients. Therefore, all patients ≥65 years old who underwent BT resection at a tertiary referral center between 01/2018 and 12/2019 were included. Age, smoking, previous radiotherapy, hypertension, preoperative functional status, complications occurrence, surgical complexity and the presence of comorbidities were prospectively collected and analyzed at discharge and the 3-month follow-up. The series included 143 patients (mean 71 years, range 65–86). Sixty-five patients (46%) had at least one neurosurgical complication, whereas 48/65 (74%) complications did not require invasive treatment. Forty-two patients (29.4%) worsened at discharge; these patients had a greater number of complications compared to patients with unchanged/improved performance status. A persistent worsening at three months of follow-up was noted in 20.3% of patients; again, this subgroup presented more complications than patients who remained equal or improved. Therefore, postoperative complications and surgical complexity seem to influence significantly the early outcome in elderly patients undergoing brain tumor surgery. In contrast, postoperative complications alone are the only factor with an impact on the 3-month follow-up.

Octogenarian Brain Tumor Registry: Single-Institution Surgical Outcomes and Mortality Study

“…In contrast, many other studies have found no association between elderly age and increased risk for complications or mortality following CTR suggesting that CTR is a safe procedure for geriatric patients. For elderly patients who do experience complications, ICH, seizure, DVT, PE, infection, and stroke are most common [ 1 7 8 10 11 12 13 14 15 16 ].…”

Prognostic Factors and Treatment Strategies for Elderly Patients with Malignant Meningioma: A SEER Population-Based Study

“…Steinberger et al revealed in their study that old age was an independent predictor of morbidity and mortality in patients undergoing craniotomy for resection of meningioma (9). Ferroli et al reported in their retrospective cohort study that postoperative complications and surgical complexity could significantly influence the early outcome in elderly patients undergoing brain tumor surgery, and postoperative complications was the only factor with a strong correlation to postoperative worsening at the 3-month follow-up (19). In another study, the authors reported that no significant difference was discovered regarding the 30-day mortality rate for elderly versus nonelderly patients, whereas elderly patients had a significantly higher complication rate compared with non-elderly patients (10).…”

Efficacy, Outcome, and Safety of Elderly Patients with Glioblastoma in the 5-ALA Era: Single Center Experience of More Than 10 Years

“…Finally, Ferroli P et al investigated different factors for postoperative outcome after brain tumor resection in elderly patients and identified the occurrence of postoperative complications as important factor for postoperative worsening at the 3-month follow-up [ 32 ]. Similarly, we also found that only one of the 11 patients with a symptomatic postsurgical hemorrhage showed improvement of neurological deficits at the 3-month follow-up visit.…”