Outcomes in Octogenarians Undergoing High-Risk Cancer Operation: A National Study
Received 5 March 2007; received in revised form 19 June 2007; accepted 19 June 2007. published online 01 October 2007.
Background
Current information about outcomes in octogenarians undergoing cancer operations is limited largely to case series from selected centers. Population-based data can provide more realistic estimates of the risks and benefits of operations in this group.
Study Design
We performed a retrospective cohort study of patients undergoing major resections for lung, esophageal, and pancreas cancer. Using the Nationwide Inpatient Sample (1994 to 2003), we examined operative mortality and discharge disposition in octogenarians (aged 80+ years), relative to younger patients (aged 65 to 69 years) (n = 272,662). We then used the Surveillance and End Results-Medicare–linked database (1992 to 2001) to measure late survival in the elderly (n = 14,088).
Results
Operative mortality among octogenarians was substantially higher than that of younger patients (aged 65 to 69 years) for all three cancers (esophagectomy, 19.9% versus 8.8%, p < 0.0001; pancreatectomy, 15.5% versus 6.7%, p < 0.0001; lung resection, 6.9% versus 3.7%, p < 0.0001). A large proportion of octogenarians were transferred to extended care facilities after operation, ranging from 24% after lung resection to 44% after esophagectomy. Five-year survival in octogenarians was low for all three cancers: 11% after pancreatectomy, 18% after esophagectomy and 31% after lung cancer resection. Survival among octogenarians with two or more comorbidities was worse than those with fewer comorbid diagnoses—10% versus 14% for pancreatectomy, 15% versus 23% for esophagectomy, and 27% versus 37% for lung resection.
Conclusions
Population-based outcomes after high-risk cancer operation in octogenarians are considerably worse than typically reported in case series and published survival statistics. Such information might better inform clinical decision making in this high-risk group.
Michigan Surgical Collaborative for Outcomes Research and Evaluation, Department of Surgery, University of Michigan, Ann Arbor, MI.
Correspondence address: Emily Finlayson, MD, MS, Michigan Surgical Collaborative for Outcomes Research and Evaluation, 211 N Fourth Ave, Ste 2A, Ann Arbor, MI 48104.
Competing Interests Declared: None.
This study was supported by the National Cancer Institute (1 R01 CA098481-01A1).
This article represents the personal viewpoint of the authors and cannot be construed as a statement of official Center for Medicare and Medicaid Services or US Government policy.
ABSTRACT