The Evaluation of Major Surgery for Cancer in the Aged

Abstract

Although there has been some improvement in attitude in the last few years, there is still a strong feeling of reluctance towards surgery in the aged, and this feeling is held not only by patients and their relatives, but also by many physicians. When the surgical problem is cancer, the reluctance is particularly evident. This attitude stems from three main factors:1. A past operative mortality rate for the elderly patient that could well be considered prohibitive.2. Unawareness of the changed prognosis resulting from surgical advances.3. Unfamiliarity with the actual life expectancy of persons in this age group. Many are surprised to learn that a man of 70 can look forward to living 9.6 years and a woman of 70, to 10.8 years; at the age of 75 the life expectancy for a man is 7.3 years and for a woman, 8.08 years; at 80 the respective figures are 5.4 and 5.83 years; and even at 85, the life expectancy is 4.11 years.There is an abundance of data that attests to the fact that the population of the United States is simultaneously expanding rapidly and aging. The relation of these two factors to the problem of cancer in the aged becomes apparent at once on considering the numbers of persons in this country past the age of 70 in the years 1900 and 1950, and the projected figures for 1960. This is a matter of major importance because of the tremendous number of persons among whom the incidence of cancer is disproportionately high (Table 1).The possible effect of the biology of senescence on the behavior of tumors may have a bearing on this problem also. There is a widespread opinion, emphasized many years ago by Finsterer, that, excluding other factors, the prognosis in the elderly cancer patient is likely to be better than average, because cancers developing in this age group are likely to be of a lower grade of malignancy. This thesis appears to be based on general impressions with little documentary support. However, it is supported by the recent experimental work of Lemon (1), who found that tumors transplanted into the cheek pouches of hamsters grew more slowly in the older animals.We believe that if all the modern surgical safeguards are used, the operative mortality in elderly patients requiring the most major surgical procedures for cancer should be about the same as that in younger patients, and that the prognosis as indicated by the standard five-year survival rate should also compare favorably with that of ordinary-risk patients. PRESENT STUDYWe are reporting on the follow-up results in 258 patients over the age of 70 who underwent major surgical procedures for carcinoma. All minor operations

Long-Term Prognosis in Geriatric Surgery: 2-17 Year Follow-Up of 7922 Patients

“…Less evident is the explanation of the definitely superior long‐term prognosis for the elderly surgical patients observed later. With the exception of malignant diseases (10–12), arteriosclerotic gangrene, emboli of the lower extremities (13–16) and fractures of the hip after surgery (17–22), the few studies available (10, 23–25) indicate that survival in elderly surgical patients is approximately identical to that in the general population for the first two to five years. The most likely explanation is that the series is a highly biased sample of the population—an hypothesis also proposed by Schottenfeld and Robbins (26).…”