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

Neuwirth, Madalyn G. ; Bierema, Christine ; Sinnamon, Andrew J. ; Fraker, Douglas L. ; Kelz, Rachel R. ; Roses, Robert E. ; Karakousis, Giorgos C.

Cancer, 2018-01, Vol.124 (1), p.125-135 [Periódico revisado por pares]

United States: Wiley Subscription Services, Inc

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Título:
Trends in major upper abdominal surgery for cancer in octogenarians: Has there been a change in patient selection?
Autor: Neuwirth, Madalyn G. ; Bierema, Christine ; Sinnamon, Andrew J. ; Fraker, Douglas L. ; Kelz, Rachel R. ; Roses, Robert E. ; Karakousis, Giorgos C.
Assuntos: Abdomen ; Abdominal surgery ; Aged, 80 and over ; Cancer ; Comorbidity ; Criteria ; Databases, Factual ; Digestive System Neoplasms - surgery ; Esophageal Neoplasms - surgery ; Esophagectomy - trends ; Esophagus ; Female ; Gastrectomy - trends ; gastrointestinal cancer ; Hepatectomy - trends ; Humans ; Incidence ; Liver ; Liver cancer ; Liver Neoplasms - surgery ; Male ; Morbidity ; Mortality ; national trends ; octogenarian ; Oncology ; outcomes ; Pancreas ; Pancreatectomy - trends ; Pancreatic cancer ; Pancreatic Neoplasms - surgery ; Patient Selection ; Regression Analysis ; Stomach ; Stomach Neoplasms - surgery ; Surgery ; Trends ; United States
É parte de: Cancer, 2018-01, Vol.124 (1), p.125-135
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Descrição: 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. © 2017 American Cancer Society. According to a large national database, total resections for esophageal, stomach, pancreatic, and liver cancers among octogenarians are increasing significantly over time, driven largely by significant increases in pancreatic and hepatic operations. These increasing trends persist after incidence adjustments for cancer within the octogenarian population along with concurrent significant decreases in mortality rates despite worsening comorbidity profiles across procedure types during the same time frame, and they are significant in that they indicate a potential paradigm shift in selection criteria for major cancer operations among the eldest patients.
Editor: United States: Wiley Subscription Services, Inc
Idioma: Inglês

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

Neuwirth, Madalyn G. ; Bierema, Christine ; Sinnamon, Andrew J. ; Fraker, Douglas L. ; Kelz, Rachel R. ; Roses, Robert E. ; Karakousis, Giorgos C.

United States: Wiley Subscription Services, Inc

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