Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?

Abstract

BACKGROUND:Although there is a general perception that, as the older population grows in number, more are undergoing surgery, there are few data on trends in major resections for cancer and short-term outcomes in this group. METHODS: The Nationwide Inpatient Sample was (NIS) used to estimate the national trends of major upper abdominal resections (esophagus, stomach, liver, pancreas) for cancer in octogenarians (aged 80 years) from 2001 to 2011. Resection rates performed per year were incidence-adjusted within this age group for each cancer type as determined by the NIS database. Joinpoint regression was used to calculate average annual percentage changes (AAPC) when evaluating trends over time. RESULTS: During the study period, octogenarians underwent an estimated 30,356 upper abdominal organ resections for cancer in the United States, representing 3.8% of all cancer admissions among octogenarians. Resection rates in octogenarians increased significantly over time (AAPC, 2.54; P < .001) secondary to increasing trends in pancreatic (AAPC, 11.52; P < .001) and hepatic (AAPC, 6.67; P < .001) resections. Elixhauser comorbidity index scores increased from a mean of 3.61 to 4.20 (AAPC, 1.31; P < .001), whereas inpatient mortality during this time decreased from 13.6% to 8.2% (AAPC, 5.58; P < .001). CONCLUSIONS: Overall rates of major upper abdominal cancer resections in octogenarians are increasing over time, driven by increases in liver and pancreatic resections. These increases were observed despite a less favorable patient morbidity profile over time. These patterns may suggest shifting selection criteria for octogenarians undergoing major abdominal surgery over time in the context of diminishing postoperative mortality. Cancer 2018;124:125-35. V C 2017 American Cancer Society.KEYWORDS: abdominal surgery, gastrointestinal cancer, national trends, octogenarian, outcomes. INTRODUCTIONOctogenarians (patients ages 80 years) have traditionally been considered at higher risk for major surgical procedures, including various types of cancer resections. This particular population is growing rapidly, with current forecasts estimating an increase in the population aged 85 years older from 1.7% of the population (5.4 million individuals) in 2008 to 7.5% of the population (projected, 27-35 million individuals) by 2050. 1 Likewise, it is estimated that adults aged 75 will increase from 18.7 million (6.1%) in 2010 to a projected 33.3 million (11%) by 2030. 2 The older population is also at the higher risk of developing cancer, with 60% of new diagnoses of malignancies occurring in those aged 65 years. 3,4 However, data reporting specific trends and outcomes in octogenarians with regard to major abdominal operations for cancer are relatively lacking. Characterization of such trends may be particularly important to help identify changes in selection criteria for surgery in this growing older adult population.Several recent studies have demonstrated similar postoperative outcomes in older adult patients compared with younger cohort...

Short-term postoperative outcomes after liver resection in the elderly patient: a nationwide population-based study

“…3 Postoperative morbidity and mortality after liver resection for primary and secondary liver tumours tend to increase as older patients are accompanied with more comorbidities and frailty as well as aging of the liver. [4][5][6] During preoperative multidisciplinary treatment meetings, preoperative optimization becomes more important to decrease the negative impact of these comorbidities of patients who face liver resection for primary and secondary liver tumours. 7 To date, age has been seen as a risk factor for complications and mortality in liver surgery but it remains unclear to what extent other patient demographics, disease burden or operative characteristics play a role.…”

Outcomes After Major Surgical Procedures in Octogenarians: A Nationwide Cohort Study

“…Comorbidities are a risk factor for occurrence of postoperative morbidity and mortality due to a decrease of functional reserve [6][7][8]. Several studies from various surgical fields on major surgical procedures in elderly patients have shown higher morbidity and mortality rates [3,[9][10][11][12]. Clinical studies have also shown that higher age and additional comorbidities of a patient can be a reason to refrain from major surgical procedures as occurrence of perioperative complications can decrease quality of life and long-term outcomes [13].…”

“…In the Netherlands, the proportion of population who were 80 years or older (octogenarians) increased from 3.2% in 2000 to 4.6% in 2019 [2]. Major surgical procedures were described to be performed more often in octogenarians after the year 2000 [3].…”

Management of adenocarcinoma of the pancreatic tail in the elderly

“…A 2007 landmark study by Bilimoria et al, utilizing data from the National Cancer Database (NCDB) (1995–2004), reported underutilization of surgical resection among patients with PC, potentially due to outdated and nihilistic views of the disease 6,7 . This hesitancy toward pancreatectomy is magnified in the elderly, which negatively impacts survival 8–10 . Our group recently reported that approximately half of octogenarians did not receive any treatment for localized pancreatic head cancer, and only 11% received chemotherapy in addition to pancreaticoduodenectomy.…”

“…6,7 This hesitancy toward pancreatectomy is magnified in the elderly, which negatively impacts survival. [8][9][10] Our group recently reported that approximately half of octogenarians did not receive any treatment for localized pancreatic head cancer, and only 11% received chemotherapy in addition to pancreaticoduodenectomy.…”