Surgical Treatment of Nonmelanoma Skin Cancer in Older Adult Veterans.

Loretta Coady-Fariborzian, Christy Anstead, Ssg Anna Paul
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Abstract

Background: Older adult patients are frequently referred to surgical services for the treatment of nonmelanoma skin cancer (NMSC). The appropriateness of offering surgery to patients with serious comorbidities and a limited life expectancy has been questioned in the literature. The purpose of this study was to determine the morbidity and 5-year mortality for patients with NMSC referred to the plastic surgery service.

Methods: A retrospective chart review was performed from July 1, 2011, to June 30, 2015, of all plastic surgery service consults for the treatment of NMSC. We collected the following data: age and life-limiting comorbidities at the time of referral, treatment, complications, and 5-year mortality. A χ2 analysis was used to determine the statistical significance (P < .05) between the individual risk factors and 5-year mortality. The relative risk of 5-year mortality was calculated combining advanced age with individual comorbidities.

Results: The plastic surgery service completed 800 consults for NMSC over a 4-year period. Five-year mortality was 28.6%. Median age of patients deceased at 5 years was 78 years at the time of the consult submission. The surgical complication rate was 5%. Aged ≥ 80 years, coronary artery disease, congestive heart failure, cerebral vascular disease, peripheral vascular disease, dementia, chronic kidney disease, chronic obstructive pulmonary disease, and diabetes mellitus were found individually to be statistically significant predictors of 5-year mortality. Combining aged ≥ 80 years, coronary artery disease, congestive heart failure, or dementia increased the 5-year mortality to a relative risk > 3.

Conclusions: Surgical excision of NMSC in older adult patients is indicated in most situations. A frank discussion with the patient and caregiver is suggested. Surgical treatment of NMSC in older adult patients has a low morbidity but needs to be balanced against a patient's quality of life when they present with life-limiting comorbidities.

Abstract Image

Abstract Image

老年退伍军人非黑色素瘤皮肤癌的外科治疗。
背景:老年患者经常被转诊到外科治疗非黑色素瘤皮肤癌(NMSC)。文献中对向有严重并发症且预期寿命有限的患者提供手术治疗是否合适提出了质疑。本研究旨在确定转诊至整形外科的 NMSC 患者的发病率和 5 年死亡率:方法:我们对 2011 年 7 月 1 日至 2015 年 6 月 30 日期间所有整形外科治疗 NMSC 的病例进行了回顾性病历审查。我们收集了以下数据:转诊时的年龄和限制性并发症、治疗、并发症和 5 年死亡率。我们采用χ2分析来确定各个风险因素与5年死亡率之间的统计学意义(P < .05)。结合高龄和个别并发症计算出了5年死亡率的相对风险:整形外科在4年内完成了800例NMSC会诊。5年死亡率为28.6%。5年后死亡患者的中位年龄为就诊时的78岁。手术并发症发生率为 5%。研究发现,年龄≥80 岁、冠状动脉疾病、充血性心力衰竭、脑血管疾病、外周血管疾病、痴呆症、慢性肾脏疾病、慢性阻塞性肺疾病和糖尿病是单独预测 5 年死亡率的重要因素。结合年龄≥80岁、冠状动脉疾病、充血性心力衰竭或痴呆症等因素,5年死亡率的相对风险大于3:结论:在大多数情况下,对老年患者进行 NMSC 手术切除是适宜的。建议与患者和护理人员进行坦诚讨论。对老年 NMSC 患者进行手术治疗的发病率较低,但当患者出现危及生命的合并症时,需要权衡患者的生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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