Pancreaticoduodenectomy and pancreaticoduodenectomy combined with superior mesentericportal vein resection for elderly cancer patients

BACKGROUND： There is an increasing frequency of pancreaticoduodenectomy（PD） and PD with superior mesenteric-portal vein（SMPV） resection in elderly cancer patients. The study aimed to investigate the safety and the survival benefits of PD and PD with SMPV resection in patients under or over 70 years of age.METHODS： We divided 296 patients who had undergone PD and PD with SMPV resection into two groups according to their ages： under or over 70 years old. The clinical data were compared between the two groups.RESULTS： Preoperative comorbidity rate was higher in elder patients than in younger patients（P=0.001）. The elder patients were more likely to have postoperative complications（P=0.003）.Specifically, complications above grade III were more likely to occur in the elderly patients（P=0.030）. Multivariable analysis showed that age（adjusted OR=2.557, P=0.015） and hypertension（adjusted OR=2.443, P=0.019） were independent predictors of postoperative complications. There was no significant difference in the mortality rates between the two groups（P=0.885）. In the PD with SMPV resection series, elderly patients were more likely to have postoperative complications（P=0.063）, but this difference was not statistically significant.There was no difference in the survival rate of patients with pancreatic ductal adenocarcinoma between the two groups.Operation type（PD vs PD with SMPV resection） did not affect the survival of patients.CONCLUSIONS： Age affects postoperative complication in patients undergoing either PD or PD with SMPV resection.However, extensive experience and advanced perioperative management lower the complication rate to an acceptablelimit. Hence it is safe and worthwhile to perform PD for elderly patients. Because of low numbers in the SMPV subset, we could not conclude whether PD with SMPV resection is feasible in elderly patients.

Impact of nutritional support on immunity,nutrition,inflammation,and outcomes in elderly gastric cancer patients after surgery

BACKGROUND Postoperative rehabilitation of elderly patients with gastric cancer has always been the focus of clinical attention.Whether the intervention by a full-course nutritional support team can have a positive impact on the postoperative immune function,nutritional status,inflammatory response,and clinical outcomes of this special population has not yet been fully verified.AIM To evaluate the impact of full-course nutritional support on postoperative comprehensive symptoms in elderly patients with gastric cancer.METHODS This is a retrospective study,including 60 elderly gastric cancer patients aged 70 years and above,divided into a nutritional support group and a control group.The nutritional support group received full postoperative nutritional support,including individualized meal formulation,and intravenous and parenteral nutrition supplementation,and was regularly evaluated and adjusted by a professional nutrition team.The control group received routine postoperative care.RESULTS After intervention,the proportion of CD4+lymphocytes(25.3%±3.1%vs 21.8%±2.9%,P<0.05)and the level of immunoglobulin G(12.5 G/L±2.3 G/L vs 10.2 G/L±1.8 G/L,P<0.01)were significantly higher in the nutritional support group than in the control group;the changes in body weight(-0.5 kg±0.8 kg vs-1.8 kg±0.9 kg,P<0.05)and body mass index(-0.2±0.3 vs-0.7±0.4,P<0.05)were less significant in the nutritional support group than in the control group;and the level of C-reactive protein(1.2 mg/L±0.4 mg/L vs 2.5 mg/L±0.6 mg/L,P<0.01)and WBC count(7.2×10^(9)/L±1.5×10^(9)/L vs 9.8×10^(9)/L±2.0×10^(9)/L,P<0.01)were significantly lower in the nutritional support group than in the control group.In addition,patients in the nutritional support group had a shorter hospital stay(10.3 d±2.1 d vs 14.8 d±3.6 d,P<0.05)and lower incidence of infection(15%vs 35%,P<0.05)in those of the control group.CONCLUSION The intervention by the nutritional support team has a positive impact on postoperative immune function,nutritional status,inflammatory response,and clinical outcomes in elderly patients with gastric cancer.

Chemotherapy of ovarian cancer in elderly patients

Epithelial ovarian cancer is primarily a disease of older women. Advanced age is risk factor for decreased survival. Optimal surgery and the safe and effective administration of chemotherapy are essential for prolonged progression-free and overall survival(OS). In this article, the available regimens in both the primary treatment and relapsed setting are reviewed.

How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center

Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.

Analysis on the Influence of PBL Teaching Method on Knowledge Awareness Rate in Teaching of Elderly Lung Cancer Nursing

Objective:To study the effect of Project-Based Learning(PBL)teaching method in lung cancer nursing teaching and its influence on knowledge awareness rates.Methods:The research subjects were 50 nursing interns who entered the same hospital for internship in 2020.The numerical ranking method was used for blind-selection and grouping,where 25 nursing interns were divided into the control group and the internship group each.Among them,the nursing interns in the control group adopted routine nursing teaching management,and the nursing interns in the training group used PBL teaching method for teaching management.The teaching satisfaction rate,teaching quality and knowledge awareness rate of the two groups were compared.Results:Nursing interns in the practice group were better than the control group in their nursing knowledge awareness rate and teaching satisfaction rate after adopting the PBL teaching method,and p<0.05.Conclusion:Through the implementation of PBL teaching method in the clinical nursing teaching of elderly lung cancer in conjunction with cancer nursing related problems,on-site answering is carried out in the way of nursing internship,so that the knowledge of nursing students in the practicing stage will be more in-depth,and the effects and quality of the nursing internship have been steadily improved,which has certain value of promotion in teaching.

The Application of Forward Control Nursing in Anesthesia, Recovery, and Rehabilitation of Thoracoscopic Lung Cancer Radical Surgery

Objective: To explore the clinical application effect of formulating the operating room nursing work procedure sheet for elderly lung cancer patients in thoracoscopic radical surgery. Methods: A total of 85 elderly patients with lung cancer treated in our hospital from May 2022 to May 2023 were included as the study population for this research. They were divided into a study group of 42 cases and a regular group of 43 cases. The regular group of elderly patients received routine nursing care, while the study group of elderly patients was provided with the operating room nursing care work procedure sheet. The surgical duration, intraoperative blood loss, time to mobilization, and postoperative complication rate were compared and analyzed between the two groups. Results: Compared to the regular group, the study group had significantly shorter surgical duration and time to mobilization, as well as less intraoperative blood loss (P < 0.05). The overall incidence of postoperative complications in the study group (4.76%) was significantly lower than that in the regular group (19.05%) (P Conclusion: Formulating the operating room nursing work procedure sheet for elderly lung cancer patients can effectively improve surgical efficiency, reduce the incidence of postoperative complications, and promote patient prognosis in thoracoscopic radical surgery. Therefore, this model is worth promoting and adopting in clinical practice.

Study on treatment and nursing of elderly patients with gastric cancer complicated with diabetes

Objective To study and analyze the treatment and nursing of elderly patients with gastric cancer complicated with diabetes.Methods:different data were analyzed and summarized.Conclusion:the elderly patients with gastric cancer and diabetes can cooperate with the control of blood glucose during the surgical treatment,and strengthen the nursing before and after the operation.

Systemic therapy of non-colorectal gastrointestinal malignancies in the elderly

In the coming years life expectancy is expected to increase and with this the percentage of the population above age 65 will grow. Patients above 65 make up more than two thirds of those currently diagnosed with gastrointestinal malignancies. Available evidence based medicine does not focus on the average patient, above the age 70, encountered in every day practice. Most guidelines and clinical trials are not designed to take into account the special considerations needed when treating the elderly such as functional status, comorbidities, polypharmacy, life expectancy, and social support. The majority of available data is based on retrospective reviews or subset analyses of larger studies where the elderly represent a fraction of the studied population. This review focuses on the toxicities and tolerability of current standard therapies for noncolorectal gastrointestinal malignancies, including gastroesophageal, pancreatic, bile duct and hepatocellular cancers in the elderly. With careful patient selection and geriatric assessment the elderly can safely benefit from standard therapies offered to younger patients.

Direct gastroscopy for detecting gastric cancer in the elderly

Objective To evaluate the safety and effectiveness of direct gastroscopy for detecting gastric cancer.Methods Clinical screening by direct gastroscopy was performed for gastric cancer (GC) from September 1985 to July 1998. 3048 elderly people were screened. Their age ranged from 60 to 93 years, and 2034 of the 3084 were followed up.Results Ninety-two patients with gastric cancer were discovered by gastroscopy, representing 3.02% of the screened population. The rate of early gastric cancer (EGC) was 63.04% (58/92) of all gastric cancers detected. The rate was up to 79.59% (39/49) on follow-up, and was 74.14% (43/51) in asymptomatic patients with gastric cancer. The excision rate was 88.89% for patients with gastric cancer, and 100% for patients with early gastric cancer. The 5-year survival rate was 91.89% for patients with gastric cancer, and 96.30% for patients with early gastric cancer. Conclusion Clinical screening and follow-up by direct gastroscopy in persons over 60 years of age are a safe and effective method for raising the 5-year survival and detection rate of gastric cancer, especially early gastric cancer.

Efficacy and feasibility of gemcitabine and carboplatin as first-line chemotherapy in elderly patients with advanced non-small cell lung cancer

Background Although platinum-based chemotherapy is a standard first-line treatment in advanced non-small cell lung cancer （NSCLC）, further research for the safety and efficacy of combination chemotherapy in elderly patients has been required. The purpose of this study was to evaluate the efficacy and safety of gemcitabine and carboplatin as first-line treatment in elderly patients with advanced NSCLC and to evaluate the prognostic factors. Methods Eligibility included： （1） age of 70 years or more, （2） histologically confirmed NSCLC, （3） chemotherapy-na＇l＇ve, （4） advanced disease with stage IIIB or IV, （5） Eastern Cooperative Oncology Group （ECOG） performance status （PS） 0-2, （6） adequate organ function. Patients received intravenous carboplatin （area under curve （AUC）=5） on day 1 and gemcitabine （1000 mg/m2） on days 1 and 8, every 3 weeks. Results The medical records of forty patients were reviewed retrospectively. Median age was 73.9 years （range, 70- 84.6）, and there were 27 men （67.5%）. Thirty-seven patients （92.5%） had ECOG PS 0-1. Adenocarcinoma was found in 57.5%. Median cycles were administrated with 4.5 per person （range： 1-6）. Best responses were partial response in 22 （55.0%） patients and stable disease （SD）in 13 （32.5%）. The median progression free survival （PFS） and overall survival （OS） were 5.9 months （95% CI： 4.5-7.3 months） and 9.6 months （95% CI： 8.2-11.0 months）, respectively. Grade 4 hematologic toxicities for neutropenia （7.5%）, thrombocytopenia （7.5%） and anemia （5.0%） were observed. Histology was significant prognostic factor for PFS （P=0.024）. Conclusion Gemcitabine and carboplatin combination chemotherapy is an effective and manageable treatment option in elderly advanced NSCLC patients with good performance status.

Geriatric oncology: problems with under-treatment within this population

We are currently faced with an aging population, which is rapidly growing worldwide. Two thirds of cancer occurs in the over 65-year age group. Societal conceptions from the past have created ageist stereotypes; old age is associated with frailty and the elderly are perceived to be destined for deterioration and loss of independence. Cancer within the elderly is also subject to these stereotypes, with elderly cancer patients considered by some not as likely to recover as younger patients with cancer. We summarise and review the current concerns regarding elderly management and treatments utilised for the management of oncological disease in the elderly, and discuss the impact of under-treatment within this population.

An Elderly Patient with Advanced Lung Cancer Achieved Long-Term Survival Using Chinese Medicine:An Alternative Treatment Strategy for Cancer Patients Aged 80 or Older without A Tissue Confirmed Diagnosis

Lung cancer is the leading cause of cancerrelated mortality in China.（1＇2） Meanwhile, the average life expectancy in the aging population has increased from 46 years in 1950 to 75 years in 2010.

Application of endoscopic mucosal advancement in the treatment of chronic anastomotic leakage:A case report

Anastomotic leakage is one of the most serious postoperative complications after colorectal surgery.A fistula or chronic sinus formation is one kind of anastomotic leakage.Most fistulas may heal after conservative treatment,but some patients will develop a chronic anastomotic leakage,which definitely requires elective surgery due to the formation of a sinus tract or an internal fistula.This study reports a case of an 88-year-old man with sigmoid colon cancer who developed a chronic anastomotic leakage after colorectal surgery.Endoscopic mucosal advancement combined with titanium clips was success-fully performed to close the fistula.The patient was discharged 12 days after the operation and resumed a normal diet 1 week after discharge.Endoscopic mucosal advancement could be an alternative choice for the treatment of chronic anastomotic leakage and can prevent a secondary surgery;however,good bowel preparation and strict inclusion criteria are required.