Morbidity and Mortality of Abdomino‐perineal Resection for Carcinoma in the Elderly

Abstract

The growing importance of geriatrics is well exemplified by the increasing number of operative procedures performed upon elderly patients at the State University of Iowa Hospitals. Figure 1 illustrates the number of aged patients admitted to the surgical services, the number of operative procedures performed on these patients and the operative mortality during the three years 1950 through 1952. During this period, 7,499 surgical procedures at which an anesthesiologist was in attendance were performed upon 5,588 patients 60 years of age or older, with 339 deaths (4.5 per cent mortality). A growing consciousness on the part of the hospital staff as to the feasibility and importance of performing indicated surgical procedures in older patients is suggested by these figures. It will be noted that the mortality rate during this three-year period has remained essentially stationary, although the surgical indications have been steadily extended to include more patients with advanced lesions requiring more formidable procedures.The surgeon must frequently decide whether or not an operation of considerable magnitude should be undertaken on the elderly patient. This problem is not posed by the emergency which demands that the indicated surgical therapy be instituted if the patient is to be salvaged. The elderly patient with adenocarcinoma of the rectum poses the type of problem to which we have reference. Can abdomino-perineal resection be justified in the patient of advanced age, or should only palliative procedures be considered if complications intervene? The established position of abdomino-perineal resection as the treatment of choice for this lesion must be weighed against the possible prohibitive morbidities and mortalities associated with aging. This paper deals with the morbidities and mortalities which occurred in elderly patients (60 years of age and older) upon whom abdomino-perineal resections were performed. PATIENTS AND PROCEDURESThe patients included in this study were operated upon during the years 1947 through 1951. In Figure 2 it will be noted that the patients have been divided into four age groups. The diagnosis in each instance was adenocarcinoma of the rectum or rectosigmoid. Lesions were arbitrarily placed within one of two groups. Those lesions included in the "without-extension" group were confined to the bowel macroscopically and microscopically; those in the "with-extension" group were shown to have spread to nodes, prostate or uterus, but were judged grossly resectable. The data suggest that there was no relationship between age and the extent of the lesion.A Miles type of abdomino-perineal resection was performed. In some instances resection of the vagina, uterus or a portion of the prostate was necessary in order 450

Morbidity and Mortality of Abdomino‐perineal Resection for Carcinoma in the Elderly

“…In the 108 patients over 60 years of age there were 13 deaths (12 per cent). These figures can be compared with a mortality rate of 10.2 per cent which resulted from 176 abdomino‐perineal resections performed for benign as well as malignant lesions in patients of all age groups during this period at the University Hospitals (1). The age, day on which death occurred, and causes of death are given in Table 2.…”

“…The data presented disclose that with increasing age there is greater likelihood that patients will have urological complications following abdomino‐perineal resection. Data obtained from a study of 176 patients in all age groups who had abdomino‐perineal resection disclose that the longest periods of postoperative hospitalization were noted in those patients with urological complications (1). This increasing urological morbidity with aging would be anticipated, since it is well established that aging is related to increasing incidence of urological difficulties in the population as a whole.…”

Abdominoperineal Resection in the Octogenarian

“…Attention must also be directed to the presence of concurrent diseases. It may be that the risks associated with concurrent disease are greater than those associated with the neoplasm (8–10). This is best determined on an individual basis for each patient.…”