Recent advances in cancer surgery in older patients

Abstract

Age is the most important risk factor for the occurrence of cancer, and a declining mortality from heart disease and other non-cancer causes leaves an older population that is at high risk of developing cancer. Choosing the optimal treatment for older cancer patients may be a challenge. Firstly, older age and associated factors such as comorbidities, functional limitations, and cognitive impairment are risk factors for adverse effects of cancer treatment. Secondly, older patients are often excluded from clinical trials, and current clinical guidelines rarely address how to manage cancer in patients who have comorbidities or functional limitations. The importance of incorporating frailty assessment into the preoperative evaluation of older surgical patients has received increasing attention over the last 10 years. Furthermore, studies that include endpoints such as functional status, cognitive status, and quality of life beyond the standard endpoints, i.e. postoperative morbidity and mortality, are starting to emerge. This review looks at recent evidence regarding geriatric assessment and frailty in older surgical cancer patients and provides a summary of newer studies in colorectal, liver, pancreatic, and gynecological cancer and renal and central nervous system tumors.

Frailty assessment in elective gastrointestinal oncogeriatric surgery: Predictors of one-year mortality and functional status

“…Consistent with this notion, incorporating a perioperative frailty assessment of older cancer patients as a way to effectively predict immediate (30-day) post-operative complications and long-term mortality outcomes is now considered a priority [56].…”

VEGF Family Gene Expression as Prognostic Biomarkers for Alzheimer’s Disease and Primary Liver Cancer

“…More than 90% of all liver cancer cases are those of hepatocellular carcinoma (HCC), for which chemotherapy and immunotherapy are currently the best treatment options [4]. Older age and associated comorbidities and cognitive impairment are detrimental factors affecting therapeutic interventions in cancer [5]. Older patients tend to be more reluctant to undergo surgery because of various reasons, such as frailty.…”

Factores asociados a complicaciones quirúrgicas en pacientes adultos mayores con neoplasias gastrointestinales del Centro Médico Naval

“…La fragilidad fue evaluada con el fenotipo de Fried modificado, que considera 5 criterios: pérdida de peso involuntaria, disminución de la fuerza muscular, actividad física reducida, lentitud en la movilidad y agotamiento. Al obtener ≥3 criterios es considerado frágil (4) .…”

“…Las neoplasias del tracto gastrointestinal presentan altas tasas de mortalidad, sobre todo el cáncer gástrico, que se ubica en el primer lugar, con 17 casos por cada 100 000 pobladores en el Perú (3) . La cirugía es una de las principales opciones para el tratamiento en el cáncer, por lo que es necesario realizar una evaluación integral en los pacientes con edad avanzada, con pruebas estandarizadas que evalúen aspectos fundamentales del paciente, para así disminuir el riesgo de complicaciones y predecir un mejor pronóstico y supervivencia (4)(5)(6) .…”

“…Estos evalúan el estado funcional, la función cognitiva y mental, el estado nutricional y entorno socioambiental (4,8) . Por ello, es necesario el uso de escalas de evaluación geriátrica como herramientas útiles para la evaluación de pacientes adultos mayores que serán sometidos a intervenciones quirúrgicas oncológicas (9) .…”