Updates in surgical oncology for elderly patients

[Complications with surgical treatment of basal cell carcinomas in individuals over 75 years of age: A retrospective study of prognostic factors in 158 cases]

INTRODUCTION

Basal cell carcinoma (BCC) is a pathology that evolves locally and it is common in elderly subjects whose frailty could restrict the indications for the reference treatment, which is based on surgery. The aim of this study was to investigate the morbidity and the mortality associated with surgical treatment of BCC in patients over 75 years of age, so as to identify possible prognostic factors for postoperative complications.

MATERIALS AND METHODS

This was a retrospective study carried out with patients over 75 years of age who were treated surgically for one or several BCC between 2010 and 2015 in the reconstructive and cosmetic plastic surgery unit of the Saint-Louis Hospital in Paris (France). We collated the demographic characteristics, the characteristics of the treatment, as well as the rate of major postoperative complications. We performed a univariate and then a multivariate analysis of the various risk factors that were identified.

RESULTS

A total of 158 patients were analyzed and they exhibited a rate of major complications of 12%. The statistical analysis identified five significant risk factors: being over 85 years of age (P=0.006), long-term use of anticoagulant treatment (P=0.02), the presence of at least one comorbidity (P=0.018), a conventional hospitalization (P=0.002), and the use of general anesthesia (P=1.2e^-10).

CONCLUSION

Five risk factors for major postoperative complications with the surgical treatment of BCC in patients over 75 years of age were identified. These factors may provide direction to medico-surgical teams in regard to the optimal treatment of BCC in elderly patients.

Risk assessment for cancer surgery in elderly patients

Global growth of the elderly population is requiring healthcare providers to cater for an expanding elderly cancer subpopulation. The aggression with which cancer should be treated in this subpopulation is an ethical dilemma and is an ongoing debate, as surgeons have feared increases in postoperative morbidity and mortality. As a result elderly patients often receive suboptimal cancer treatment. The need for standardization of cancer surgery is well recognized despite the difficulties in view of heterogeneity of the group. In this article, epidemiological changes, tumor biology specific to elderly cancer are visited, operative risk assessment tools are discussed, and interim results of ongoing multinational investigation ie, PACE (Preoperative Assessment of Cancer Elderly) revealed.

The surgical management of elderly cancer patients

Although cancer in the elderly is extremely common, few health professionals in oncology are familiar with caring for series of oncogeriatric patients. Surgery is at present the first choice, but is frequently delivered suboptimally: under-treatment is justified by concerns about unsustainable toxicity, whilst over-treatment is explained by the lack of knowledge in optimising preoperative risk assessment. This article summarises the point of view of the Surgical Task Force @ SIOG (International Society for Geriatric Oncology), pointing out differences from, and similarities to, the younger cohorts of cancer patients, and highlighting the latest updates and trends specifically related to senior cancer patients.