Sicherheit und Effektivität der Tumorchirurgie im Alter

Chapter
Part of the Springer Reference Medizin book series (SRM)

Zusammenfassung

Die Chirurgie stellt für die meisten soliden Tumoren die einzige kurative Therapieoption dar. Daher muss auch bei geriatrisch-onkologischen Patienten in entsprechenden Tumorstadien ein operatives Vorgehen angestrebt werden. Der Selektion von für eine Tumoroperation geeigneten Patienten und der partizipativen Entscheidungsfindung, unter Berücksichtigung spezifischer Gegebenheiten beim älteren Menschen, kommt eine entscheidende Rolle zu. Eine strukturierte Vorbereitung auf die Operation (prehabilitation) und eine postoperative Behandlung mit dem Ziel einer geringen Beeinträchtigung der präoperativen Homöostase und eines weitreichenden Erhaltens der körperlichen Autonomie (Enhanced Recovery After Surgery, ERAS) können helfen, die postoperative Rekonvaleszenz zu beschleunigen. Fallserien zeigen, dass sich Tumoroperationen bei geriatrischen Patienten mit guten Ergebnissen durchführen lassen. Allerdings kann hier ein Selektionsbias nicht ausgeschlossen werden, so dass prospektiv-kontrollierte Studien benötigt werden.

Literatur

  1. Audisio RA, Pope D, Ramesh HS, Gennari R, van Leeuwen BL, West C, Corsini G, Maffezzini M, Hoekstra HJ, Mobarak D, Bozzetti F, Colledan M, Wildiers H, Stotter A, Capewell A, Marshall E (2008) Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol 65:156–163CrossRefPubMedGoogle Scholar
  2. Bagnall NM, Malietzis G, Kennedy RH, Athanasiou T, Faiz O, Darzi A (2014) A systematic review of enhanced recovery care after colorectal surgery in elderly patients. Colorectal Dis 16:947–956CrossRefPubMedGoogle Scholar
  3. Barratt A (2008) Evidence based medicine and shared decision making: the challenge of getting both evidence and preferences into health care. Patient Educ Couns 73:407–412CrossRefPubMedGoogle Scholar
  4. Coolsen MM, Bakens M, van Dam RM, Olde Damink SW, Dejong CH (2015) Implementing an enhanced recovery program after pancreaticoduodenectomy in elderly patients: is it feasible? World J Surg 39:251–258CrossRefPubMedGoogle Scholar
  5. Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360CrossRefPubMedGoogle Scholar
  6. Cucchetti A, Sposito C, Pinna AD, Citterio D, Ercolani G, Flores M, Cescon M, Mazzaferro V (2016) Effect of age on survival in patients undergoing resection of hepatocellular carcinoma. Br J Surg 103:e93–e99CrossRefPubMedGoogle Scholar
  7. De Marzi P, Ottolina J, Mangili G, Rabaiotti E, Ferrari D, Vigano R, Candiani M (2013) Surgical treatment of elderly patients with endometrial cancer (>/= 65 years). J Geriatr Oncol 4:368–373Google Scholar
  8. Dunn GP (2016) Shared decision-making for the elderly patient with a surgical condition. Br J Surg 103:e19–e20CrossRefPubMedGoogle Scholar
  9. Findlay JM, Gillies RS, Millo J, Sgromo B, Marshall RE, Maynard ND (2014) Enhanced recovery for esophagectomy: a systematic review and evidence-based guidelines. Ann Surg 259:413–431CrossRefPubMedGoogle Scholar
  10. George EM, Tergas AI, Ananth CV, Burke WM, Lewin SN, Prendergast E, Neugut AI, Hershman DL, Wright JD (2014) Safety and tolerance of radical hysterectomy for cervical cancer in the elderly. Gynecol Oncol 134:36–41CrossRefPubMedPubMedCentralGoogle Scholar
  11. Gonzalez-Ayora S, Pastor C, Guadalajara H, Ramirez JM, Royo P, Redondo E, Arroyo A, Moya P, Garcia-Olmo D (2016) Enhanced recovery care after colorectal surgery in elderly patients. Compliance and outcomes of a multicenter study from the Spanish working group on ERAS. Int J Colorectal Dis 31:1625–1631CrossRefPubMedPubMedCentralGoogle Scholar
  12. Harter M, Buchholz A, Nicolai J, Reuter K, Komarahadi F, Kriston L, Kallinowski B, Eich W, Bieber C (2015) Shared decision making and the use of decision aids. Dtsch Arztebl Int 112:672–679PubMedPubMedCentralGoogle Scholar
  13. Huisman MG, van Leeuwen BL, Ugolini G, Montroni I, Spiliotis J, Stabilini C, de’Liguori CN, Farinella E, de Bock GH, Audisio RA (2014) „Timed up & go“: a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study. PLoS One 9:e86863CrossRefPubMedGoogle Scholar
  14. Hulzebos EH, van Meeteren NL (2016) Making the elderly fit for surgery. Br J Surg 103:e12–e15CrossRefPubMedGoogle Scholar
  15. Ihedioha U, Gravante G, Lloyd G, Sangal S, Sorge R, Singh B, Chaudhri S (2013) Curative colorectal resections in patients aged 80 years and older: clinical characteristics, morbidity, mortality and risk factors. Int J Colorectal Dis 28:941–947CrossRefPubMedGoogle Scholar
  16. Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, Kaneva P, Augustin B, Wongyingsinn M, Gamsa A, Kim DJ, Vassiliou MC, Feldman LS (2013) Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27(4):1072–82Google Scholar
  17. Makoul G, Clayman ML (2006) An integrative model of shared decision making in medical encounters. Patient Educ Couns 60:301–312CrossRefPubMedGoogle Scholar
  18. Mans CM, Reeve JC, Gasparini CA, Elkins MR (2012) Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing open cardiothoracic or upper abdominal surgery: protocol for a systematic review. Syst Rev 1:63CrossRefPubMedPubMedCentralGoogle Scholar
  19. Markar SR, Karthikesalingam A, Thrumurthy S, Ho A, Muallem G, Low DE (2013) Systematic review and pooled analysis assessing the association between elderly age and outcome following surgical resection of esophageal malignancy. Dis Esophagus 26:250–262CrossRefPubMedGoogle Scholar
  20. Miyata H, Yamasaki M, Makino T, Miyazaki Y, Takahashi T, Kurokawa Y, Nakajima K, Takiguchi S, Mori M, Doki Y (2015) Clinical outcome of esophagectomy in elderly patients with and without neoadjuvant therapy for thoracic esophageal cancer. Ann Surg Oncol 22(Suppl 3):S794–S801CrossRefPubMedGoogle Scholar
  21. Mortensen K, Nilsson M, Slim K, Schafer M, Mariette C, Braga M, Carli F, Demartines N, Griffin SM, Lassen K (2014) Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS(R)) Society recommendations. Br J Surg 101:1209–1229CrossRefPubMedGoogle Scholar
  22. Nardo B, Serafini S, Ruggiero M, Grande R, Fugetto F, Zullo A, Novello M, Rizzuto A, Bonaiuto E, Vaccarisi S, Cavallari G, Serra R, Cannistra M, Sacco R (2016) Liver resection for metastases from colorectal cancer in very elderly patients: new surgical horizons. Int J Surg 33:S135–S141CrossRefPubMedGoogle Scholar
  23. Nitsche U, Spath C, Muller TC, Maak M, Janssen KP, Wilhelm D, Kleeff J, Bader FG (2014) Colorectal cancer surgery remains effective with rising patient age. Int J Colorectal Dis 29:971–979CrossRefPubMedPubMedCentralGoogle Scholar
  24. Partelli S, Crippa S, Castagnani R, Ruffo G, Marmorale C, Franconi AM, De AC, Falconi M (2016) Evaluation of an enhanced recovery protocol after pancreaticoduodenectomy in elderly patients. HPB (Oxford) 18:153–158CrossRefGoogle Scholar
  25. Podsiadlo D, Richardson S (1991) The timed „up & go“: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148CrossRefPubMedGoogle Scholar
  26. Pope D, Ramesh H, Gennari R, Corsini G, Maffezzini M, Hoekstra HJ, Mobarak D, Sunouchi K, Stotter A, West C, Audisio RA (2006) Pre-operative assessment of cancer in the elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol 15:189–197CrossRefPubMedGoogle Scholar
  27. Radwan RW, Evans MD, Davies M, Harris DA, Beynon J (2016) Pelvic exenteration for advanced malignancy in elderly patients. Br J Surg 103:e115–e119CrossRefPubMedGoogle Scholar
  28. Richter A, Niedergethmann M, Lorenz D, Sturm JW, Trede M, Post S (2002) Resection for cancers of the pancreatic head in patients aged 70 years or over. Eur J Surg 168:339–344CrossRefPubMedGoogle Scholar
  29. Santa MD, Clarke H, Ritvo P, Leung YW, Matthew AG, Katz J, Trachtenberg J, Alibhai SM (2014) Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy 100:196–207CrossRefGoogle Scholar
  30. Schiffmann J, Gandaglia G, Larcher A, Sun M, Tian Z, Shariat SF, McCormack M, Valiquette L, Montorsi F, Graefen M, Saad F, Karakiewicz PI (2014) Contemporary 90-day mortality rates after radical cystectomy in the elderly. Eur J Surg Oncol 40:1738–45.CrossRefPubMedGoogle Scholar
  31. Song W, Wang K, Zhang RJ, Dai QX, Zou SB (2016) The enhanced recovery after surgery (ERAS) program in liver surgery: a meta-analysis of randomized controlled trials. Springerplus 5:207CrossRefPubMedPubMedCentralGoogle Scholar
  32. Soreide K, Wijnhoven BP (2016) Surgery for an ageing population. Br J Surg 103:e7–e9CrossRefPubMedGoogle Scholar
  33. Sukharamwala P, Thoens J, Szuchmacher M, Smith J, DeVito P (2012) Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB (Oxford) 14:649–657CrossRefGoogle Scholar
  34. Varadhan KK, Lobo DN, Ljungqvist O (2010) Enhanced recovery after surgery: the future of improving surgical care. Crit Care Clin 26:527–547, xCrossRefPubMedGoogle Scholar
  35. Xiong J, Szatmary P, Huang W, de la Iglesia-Garcia D, Nunes QM, Xia Q, Hu W, Sutton R, Liu X, Raraty MG (2016) Enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy: a PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 95:e3497CrossRefGoogle Scholar
  36. Yang JY, Lee HJ, Kim TH, Huh YJ, Son YG, Park JH, Ahn, HS, Suh YS, Kong SH, Yang HK (2017) Short- and long-term outcomes after gastrectomy in elderly gastric cancer patients. Ann Surg Oncol 24(2):469–477Google Scholar
  37. Yap R, Oliva K, Wilkins S, McMurrick PJ (2016) Colorectal cancer surgery in the very elderly: nonagenarians. Dis Colon Rectum 59:501–507CrossRefPubMedGoogle Scholar
  38. Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z (2013) Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 56:667–678CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Klinik für Gefäßchirurgie und Endovaskuläre ChirurgieUniversitätsklinikum HeidelbergHeidelbergDeutschland
  2. 2.Chirurgische KlinikUniversitätsmedizin MannheimMannheimDeutschland

Section editors and affiliations

  • Matthias Ebert
    • 1
  1. 1.II. Medizinischen KlinikUniversitätsmedizin MannheimMannheimDeutschland

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