Skip to main content
Erschienen in: Surgery Today 10/2019

22.04.2019 | Original Article

Super-elderly patient-specific perioperative complications in breast cancer surgery

verfasst von: Yoshinari Ogawa, Katsumi Ikeda, Chika Watanabe, Yuri Kamei, Wataru Goto, Chika Shiraishi, Shinya Tokunaga, Yuko Tsuboguchi

Erschienen in: Surgery Today | Ausgabe 10/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Geriatric surgery poses specific challenges due to patient vulnerability in relation to aging. We analyzed perioperative challenges concerning super-elderly patients with breast cancer.

Methods

Between 2013 and 2018, 908 patients with breast cancer were treated surgically. Of these, two patient groups were compared: Group A (≥ 85 years old, n = 34, 3.7%) and Group B (75–84 years old, n = 136, 15%).

Results

In Groups A and B, 26.4% and 36.8% of patients lived alone, respectively. Group A patients had higher rates of psychiatric and cardiovascular disease (32.4% and 41.2%) than Group B (8.8% and 16.2%) (p = 0.0009 and p = 0.0031, respectively). There was no marked difference in the type of surgery or length of hospital stay between groups, and most complications involved surgical site disorders. Postoperatively, Group A had a higher rate of delirium (29.4%) than Group B (3.7%) (p < 0.0001). The 30-day postoperative mortality rate was 0, and 76.5% of Group A and 45.6% of Group B patients received no adjuvant therapy (p = 0.0024).

Conclusions

Age alone does not constitute a contraindication for appropriate surgery, although there are some challenges necessary to consider for super-elderly patients.
Literatur
2.
Zurück zum Zitat National Cancer Center Japan (in Japanese). gdb.ganjoho.jp/grph_db/gadb1?smTypes=14 National Cancer Center Japan (in Japanese). gdb.ganjoho.jp/grph_db/gadb1?smTypes=14
3.
Zurück zum Zitat Evron E, Goldberg H, Kuzmin A, Gutman R, Rizel S, Sella A, et al. Breast cancer in octogenarians. Cancer. 2006;106:1664–8.CrossRefPubMed Evron E, Goldberg H, Kuzmin A, Gutman R, Rizel S, Sella A, et al. Breast cancer in octogenarians. Cancer. 2006;106:1664–8.CrossRefPubMed
4.
Zurück zum Zitat Rao VS, Jameel JK, Mahapatra TK, McManus PL, Fox JN, Drew PJ. Surgery is associated with lower morbidity and longer survival in elderly breast cancer patients over 80. Breast J. 2007;13:368–73.CrossRefPubMed Rao VS, Jameel JK, Mahapatra TK, McManus PL, Fox JN, Drew PJ. Surgery is associated with lower morbidity and longer survival in elderly breast cancer patients over 80. Breast J. 2007;13:368–73.CrossRefPubMed
5.
Zurück zum Zitat Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M. Non-standard management of breast cancer increases with age in the UK: a population based cohort of women %3e or =65 years. Br J Cancer. 2007;96:1197–203.CrossRefPubMedPubMedCentral Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M. Non-standard management of breast cancer increases with age in the UK: a population based cohort of women %3e or =65 years. Br J Cancer. 2007;96:1197–203.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010;124:801–7.CrossRefPubMed Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010;124:801–7.CrossRefPubMed
7.
Zurück zum Zitat Hind D, Wyld L, Beverley CB, Reed MW. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev. 2006;5:CD004272. Hind D, Wyld L, Beverley CB, Reed MW. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev. 2006;5:CD004272.
8.
Zurück zum Zitat Kantor O, Pesce C, Liederbach E, Wang CH, Winchester DJ, Yao K. Surgery and hormone therapy trends in octogenarians with invasive breast cancer. Am J Surg. 2016;211:541–5.CrossRefPubMed Kantor O, Pesce C, Liederbach E, Wang CH, Winchester DJ, Yao K. Surgery and hormone therapy trends in octogenarians with invasive breast cancer. Am J Surg. 2016;211:541–5.CrossRefPubMed
9.
Zurück zum Zitat Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.CrossRefPubMed Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.CrossRefPubMed
10.
Zurück zum Zitat Chatzidaki P, Mellos C, Briese V, Mylonas I. Perioperative complications of breast cancer surgery in elderly women (≥80 years). Ann Surg Oncol. 2011;18:923–31.CrossRefPubMed Chatzidaki P, Mellos C, Briese V, Mylonas I. Perioperative complications of breast cancer surgery in elderly women (≥80 years). Ann Surg Oncol. 2011;18:923–31.CrossRefPubMed
11.
Zurück zum Zitat de Glas NA, Kiderlen M, Bastiaannet E, de Craen AJM, van de Water W, van de Velde CJH, et al. Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis. Breast Cancer Res Treat. 2013;138:561–9.CrossRefPubMed de Glas NA, Kiderlen M, Bastiaannet E, de Craen AJM, van de Water W, van de Velde CJH, et al. Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis. Breast Cancer Res Treat. 2013;138:561–9.CrossRefPubMed
12.
Zurück zum Zitat Petteke E, Ilonzo N, Ayewah M, Tsantes S, Estabrook A, Ma AMT. Short-term, postoperative breast cancer outcomes in patients with advanced age. Am J Surg. 2016;212:677–81.CrossRef Petteke E, Ilonzo N, Ayewah M, Tsantes S, Estabrook A, Ma AMT. Short-term, postoperative breast cancer outcomes in patients with advanced age. Am J Surg. 2016;212:677–81.CrossRef
13.
Zurück zum Zitat Angarita FA, Acuna SA, Cordeiro E, Elnahas A, Sutradhar S, Jackson T, et al. Thirty-day postoperative morbidity and mortality in elderly women with breast cancer: an analysis of the NSQIP database. Breast Cancer Res Treat. 2018;170:373–9.CrossRefPubMed Angarita FA, Acuna SA, Cordeiro E, Elnahas A, Sutradhar S, Jackson T, et al. Thirty-day postoperative morbidity and mortality in elderly women with breast cancer: an analysis of the NSQIP database. Breast Cancer Res Treat. 2018;170:373–9.CrossRefPubMed
15.
Zurück zum Zitat Fried LP, Tanger CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:146–56.CrossRef Fried LP, Tanger CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:146–56.CrossRef
17.
Zurück zum Zitat 8th Edition of the UICC TNM classification of Malignant Tumors. In: Japanese Breast Cancer Society. General Rules for Clinical and Pathological Recording of Breast Cancer, 1th edn. Tokyo: Kanehara-shuppan; 201. 103–109. 8th Edition of the UICC TNM classification of Malignant Tumors. In: Japanese Breast Cancer Society. General Rules for Clinical and Pathological Recording of Breast Cancer, 1th edn. Tokyo: Kanehara-shuppan; 201. 103–109.
18.
Zurück zum Zitat Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The delirium observation screening scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17:31–50.CrossRefPubMed Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The delirium observation screening scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17:31–50.CrossRefPubMed
19.
Zurück zum Zitat Land LH, Dalton SO, Jensen MB, Ewertz M. Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer. 1990–2008. Land LH, Dalton SO, Jensen MB, Ewertz M. Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer. 1990–2008.
20.
Zurück zum Zitat Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst. 2011;103:1101–11.CrossRefPubMedPubMedCentral Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst. 2011;103:1101–11.CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat GDB 2016 Dementia Collaborators. Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:88–106. GDB 2016 Dementia Collaborators. Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:88–106.
22.
Zurück zum Zitat Gajdos C, Kile D, Hawn MT, Finlayson E, Henderson WG, Robinson TN. Advancing age and 30-day adverse outcomes after nonemergent general surgeries. J Am Geriatr Soc. 2013;61:1608–14.CrossRefPubMedPubMedCentral Gajdos C, Kile D, Hawn MT, Finlayson E, Henderson WG, Robinson TN. Advancing age and 30-day adverse outcomes after nonemergent general surgeries. J Am Geriatr Soc. 2013;61:1608–14.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009;103(1):41–6.CrossRef Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009;103(1):41–6.CrossRef
24.
Zurück zum Zitat Raats JW, van Eijsden WA, Crolla RMPH, Steyerberg EW, van der Laan L. Risk factors and outcomes for postoperative delirium after major surgery in elderly patients. PLoS One. 2015;10:e136071.CrossRef Raats JW, van Eijsden WA, Crolla RMPH, Steyerberg EW, van der Laan L. Risk factors and outcomes for postoperative delirium after major surgery in elderly patients. PLoS One. 2015;10:e136071.CrossRef
25.
Zurück zum Zitat Inouye SK, Bogardus ST, Charpentier PA, LEO-Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–76.CrossRefPubMed Inouye SK, Bogardus ST, Charpentier PA, LEO-Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–76.CrossRefPubMed
Metadaten
Titel
Super-elderly patient-specific perioperative complications in breast cancer surgery
verfasst von
Yoshinari Ogawa
Katsumi Ikeda
Chika Watanabe
Yuri Kamei
Wataru Goto
Chika Shiraishi
Shinya Tokunaga
Yuko Tsuboguchi
Publikationsdatum
22.04.2019
Verlag
Springer Singapore
Erschienen in
Surgery Today / Ausgabe 10/2019
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01812-x

Weitere Artikel der Ausgabe 10/2019

Surgery Today 10/2019 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.