title: Upper abdominal cancer surgery in the very elderly.
abstract: From January 1981 to December 1987, 59 major upper abdominal operations were performed on 57 patients aged 80 to 90 years at Memorial Sloan-Kettering Cancer Center. Procedures for primary adenocarcinoma of the stomach, distal esophagus, pancreas, or hepatobiliary system were performed with curative intent or for palliation in 34 of 59 patients (58%) and bypass with limited or no resection in 13 of 59 patients (22%) patients. Emergency operations were performed in six (10%) patients for gastric bleeding, perforation, or outlet obstruction. Six (10%) patients underwent laparotomy for benign biliary obstruction (1), splenectomy for secondary thrombocytopenia (2), or gastrectomy for sarcoma (2) or lymphoma (1). Hospital mortality was 15% overall and 9% for major resections, 15% for bypass, and 67% for emergency procedures. Major complications occurred in 10 (20%) elective procedures. Mortality was associated with respiratory or cardiac failure while complications most commonly included arrhythmias and wound infection. Mean postoperative hospitalization was 18 days overall and 45 patients (76%) were discharged home. Median survival following major resection was 17.5 months but less than 2 months after bypass procedures. A protocol of pre-operative evaluation, intra-operative hemodynamic monitoring and postoperative intensive care has been formalized for use in elderly or poor-risk patients.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: H R
authors.initials: HR
authors.lastname: Alexander
authors.forename: A D
authors.initials: AD
authors.lastname: Turnbull
authors.forename: J
authors.initials: J
authors.lastname: Salamone
authors.forename: D
authors.initials: D
authors.lastname: Keefe
authors.forename: J
authors.initials: J
authors.lastname: Melendez
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D001661:Biliary Tract Neoplasms / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D010190:Pancreatic Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery