Major Gastrointestinal Cancer Resections in the Elderly in India: Poised for Future Challenges

Abstract

Background: There are no data on surgical outcomes of major gastrointestinal cancer resections in the expanding Indian oncogeriatric population. Methods: A prospective database of patients who underwent major gastrointestinal cancer resections during varying time periods (2006-2014) was analyzed retrospectively. Results: Two thousand six hundred and forty three patients with a median age of 53 were analyzed. Four hundred and seventy two (17.9%) patients were aged ≥65 years and 235 (8.9%) patients were ≥70 years. Mortality rates were not significantly higher in the elderly (≥65 years) or the very elderly (≥70 years) when compared to younger controls, being 2.8 vs. 1.6% (p = 0.09) and 3.0 vs. 1.7% (p = 0.162) respectively. Overall morbidity was similar for patients ≥65 or <65 years (24.2 vs. 21.7%, p = 0.253), but was higher in patients ≥70 years (29.8 vs. 21.4%, p = 0.003). The incidence of severe complications, however, was not significantly greater in this age group (13.2 vs. 12.5%, p = 0.74). Conclusions: Major gastrointestinal cancer resections in the elderly Indian population, though uncommon, are safe when performed at experienced high volume centres. These results should serve as a starting point for the gradual development of dedicated oncogeriatric programs in the Indian subcontinent.

Twelve Hundred Consecutive Pancreato‐Duodenectomies from Single Centre: Impact of Centre of Excellence on Pancreatic Cancer Surgery Across India

“…Period B also witnessed the widest and biggest expansion of surgical oncology residency programme for speciality trainees across India. Service reconfiguration into specialised pancreatic surgery contributed to a dedicated focus with further increase in volumes of more than 150 PDs per year along with integration of minimally invasive pancreatic surgery protocols and perhaps enhanced quality of perioperative care [31]. Although majority of cases in our series are by open approach, our experience with minimally invasive pancreatic resection continues to evolve with current focus on patient selection and standardisation of the surgical steps.…”

Pancreaticoduodenectomy in the Elderly Patient: Age-Adapted Risk Assessment

“…In addition, elderly patients (>70 years) who were obese and had CVD had an increased risk of major complications when compared with the younger study population (p = 0.010), whereas healthy elderly patients did not show any increased risk of complications. A recent large-scale study by Batra et al [25] found that patients aged ≥ 70 years who underwent major gastrointestinal cancer resection had a higher incidence of minor surgical and non-surgical complications when compared with younger controls. This finding is consistent with our study, in which an increased incidence of comorbidities and obesity was associated with an increased rate of complications.…”