Evolution of the elderly surgical oncologic patient. Case Analysis

Abstract

Introduction: The old (≥65 years) patient is common in modern surgery and implies complex challenges regarding the perioperative management and outcome. Objective: The analysis of epidemiological and outcome data in old oncologic patients submitted to surgery. Method: The retrospective observational study included all old oncologic patients submitted to surgery between 1.01-31.12.2017 in IRO Iași. Recorded parameters: age, data about cancer (organ, stage), co-morbidities, ASA score, data about surgery (organ, type, minor/major, duration), type of anesthesia, ICU lenght of stay, complications and outcome. Statistical analysis was performed with SPSS and MEDCALC. Results: The study group included 971 patients ≥65 years, which represent 23% of all oncological patients submitted to surgery during 2017 in IRO Iași. 67% pts were between 65-74 years. 498 pts (51%) had digestive cancer. 577 pts (60%) were ASA III. 939 pts (97%) had general anesthesia. In 502 pts (81%) surgery was performed with the intent to cure. In 268 pts (26%) total resection of single/multiple organs was performed. Mean duration of surgery was 127(10-450) minutes. 35 pts (4%) needed postoperative mechanical ventilation. The most frequent postoperative complication was renal failure (80 pts, 8.2%). 6 patients (0.6%) died. Conclusions: The old oncologic patient is frequently submitted to major, long-lasting surgery with the intent to cure. The constant application of multiple strategies in order to optimize the perioperative course results in low postoperative complications and mortality.