Marij Hartog, Sara J. E. Beishuizen, Reon Togo, Rozemarijn L. van Bruchem‐Visser, Casper H. J. van Eijck, Francesco U. S. Mattace‐Raso, Chulja J. Pek, Roeland F. de Wilde, Bas Groot Koerkamp, Harmke A. Polinder‐Bos
{"title":"Comprehensive Geriatric Assessment, Treatment Decisions, and Outcomes in Older Patients Eligible for Pancreatic Surgery","authors":"Marij Hartog, Sara J. E. Beishuizen, Reon Togo, Rozemarijn L. van Bruchem‐Visser, Casper H. J. van Eijck, Francesco U. S. Mattace‐Raso, Chulja J. Pek, Roeland F. de Wilde, Bas Groot Koerkamp, Harmke A. Polinder‐Bos","doi":"10.1002/jso.27862","DOIUrl":null,"url":null,"abstract":"IntroductionPeriampullary cancer has a poor prognosis. Surgical resection is a potentially curative but high‐risk treatment. Comprehensive geriatric assessment (CGA) can inform treatment decisions, but has not yet been evaluated in older patients eligible for pancreatic surgery.MethodsThis prospective observational study included patients ≥ 70 years of age eligible for pancreatic surgery. Frailty was defined as impairment in at least two of five domains: somatic, psychological, functional, nutritional, and social. Outcomes included postoperative complications, functional decline, and mortality.ResultsOf the 88 patients included, 87 had a complete CGA. Sixty‐five patients (75%) were frail and 22 (25%) were non‐frail. Frail patients were more likely to receive nonsurgical treatment (43.1% vs. 9.1% <jats:italic>p</jats:italic> = 0.004). Fifty‐seven patients underwent surgery, of which 52 (59%) underwent pancreaticoduodenectomy. The incidence of postoperative delirium was three times higher in frail patients (29.7% vs. 0%, <jats:italic>p</jats:italic> = 0.005). The risk of mortality was three times higher in frail patients (HR: 3.36, 95% CI: 1.43–7.89, <jats:italic>p</jats:italic> = 0.006).ConclusionFrailty is common in older patients eligible for pancreatic surgery and is associated with treatment decision, a higher incidence of delirium and a three times higher risk of all‐cause mortality. CGA can contribute to shared decision‐making and optimize perioperative care in older patients.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.0000,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jso.27862","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
IntroductionPeriampullary cancer has a poor prognosis. Surgical resection is a potentially curative but high‐risk treatment. Comprehensive geriatric assessment (CGA) can inform treatment decisions, but has not yet been evaluated in older patients eligible for pancreatic surgery.MethodsThis prospective observational study included patients ≥ 70 years of age eligible for pancreatic surgery. Frailty was defined as impairment in at least two of five domains: somatic, psychological, functional, nutritional, and social. Outcomes included postoperative complications, functional decline, and mortality.ResultsOf the 88 patients included, 87 had a complete CGA. Sixty‐five patients (75%) were frail and 22 (25%) were non‐frail. Frail patients were more likely to receive nonsurgical treatment (43.1% vs. 9.1% p = 0.004). Fifty‐seven patients underwent surgery, of which 52 (59%) underwent pancreaticoduodenectomy. The incidence of postoperative delirium was three times higher in frail patients (29.7% vs. 0%, p = 0.005). The risk of mortality was three times higher in frail patients (HR: 3.36, 95% CI: 1.43–7.89, p = 0.006).ConclusionFrailty is common in older patients eligible for pancreatic surgery and is associated with treatment decision, a higher incidence of delirium and a three times higher risk of all‐cause mortality. CGA can contribute to shared decision‐making and optimize perioperative care in older patients.
期刊介绍:
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.