Real-World Outcomes of High-Risk Cancer Surgery Poor in Very Elderly

By Scott Baltic

NEW YORK JAN 17, 2008 (Reuters Health) - Patients who are 80 and over are much more likely to have a poor outcome after high-risk cancer surgery than has previously been reported, according to a recent retrospective study by researchers with the University of Michigan Healthcare System. The study appears in the December issue of the Journal of the American College of Surgeons.

Case series published over the past 10 years have indicated that operative mortality rates for lung, esophageal and pancreatic resections in the very elderly vary between 3% and 4%.

However, Dr. Emily Finlayson told Reuters Health, "There seemed to be a disconnect between what we saw reported in the literature -- that elderly patients have low operative mortality -- and "real world" surgical results."

Using data from the Nationwide Inpatient Sample and the Surveillance Epidemiology and End Results-Medicare database, Dr. Finlayson and colleagues identified about 200,000 patients aged 65 and over who had undergone surgery for lung, esophageal and pancreatic cancer between 1994 and 2003, more than 30,000 of whom were 80 and over.

The researchers found that for all three procedures, "operative mortality in patients aged 80 years and older was substantially higher than in younger patients." The greatest difference was in esophagectomy, where mortality was 19.9% in octogenarians versus 8.8% in those 65-69 years old.

Older age also was associated with a lower likelihood of being discharged to home after surgery. Following esophageal resection, for example, only 54% of those 80 and older were discharged to home, versus 84% of those 65-69.

In addition, longer-term survival decreased with age for all three types of cancer surgery. The difference in 5-year survival was greatest for lung cancer: 31% in octogenarians versus 47% of those 65-69.

For all three cancers, having two or more comorbidities was also associated with lower 5-year survival rates.

"On the individual patient and provider level, physicians who counsel elderly patients need realistic data about risks and long-term benefits of major cancer operations," the researchers note.

"Ideally," Dr. Finlayson told Reuters, "we will at some point be able to design an instrument that takes into account a patient"s medical and functional status and generate a risk estimate for patients and their families. This would be an invaluable decision aid for doctors and patients."

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