1
|
Belgrano V, Ramello M, Montroni I, Audisio RA. Surgical oncology in the elderly. Acta Chir Belg 2020; 120:401-403. [PMID: 31328639 DOI: 10.1080/00015458.2019.1642598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Poor cancer-specific outcomes in the elderly group are primarily a surgical failure. Surgeons are insufficiently trained to draw a line between fit and frail patients; this results in over-treatment of the frail patient, as well as under-treatment of the fit one. Communication skills should be improved to better understand the patient's requests. The timing of the surgical procedure is crucially important; all efforts should be put in place to optimize the patient's conditions before the surgery takes place.
Collapse
Affiliation(s)
- Valerio Belgrano
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Policlinico San Martino, University General Hospital, University of Genoa, Genoa, Italy
| | - Monica Ramello
- Department of Medical Oncology, Azienda Sanitaria Universitaria Integrata di Trieste, Ospedale Maggiore, Trieste, Italy
| | - Isacco Montroni
- Colorectal Surgery and General Surgery, Ospedale per gli Infermi, Faenza, Italy
| | - Riccardo A. Audisio
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Göteborg, Sweden
| |
Collapse
|
2
|
Williams DGA, Ohnuma T, Krishnamoorthy V, Raghunathan K, Sulo S, Cassady BA, Hegazi R, Wischmeyer PE. Postoperative Utilization of Oral Nutrition Supplements in Surgical Patients in US Hospitals. JPEN J Parenter Enteral Nutr 2020; 45:596-606. [DOI: 10.1002/jpen.1862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Affiliation(s)
- David G. A. Williams
- CAPER Unit Department of Anesthesiology Duke University School of Medicine Durham North Carolina USA
- Duke Clinical Research Institute Durham North Carolina USA
| | - Tetsu Ohnuma
- CAPER Unit Department of Anesthesiology Duke University School of Medicine Durham North Carolina USA
| | - Vijay Krishnamoorthy
- CAPER Unit Department of Anesthesiology Duke University School of Medicine Durham North Carolina USA
| | - Karthik Raghunathan
- CAPER Unit Department of Anesthesiology Duke University School of Medicine Durham North Carolina USA
| | | | | | - Refaat Hegazi
- Abbott Nutrition Columbus Ohio USA
- Faculty of Medicine Mansoura University Mansoura Egypt
| | - Paul E. Wischmeyer
- CAPER Unit Department of Anesthesiology Duke University School of Medicine Durham North Carolina USA
- Duke Clinical Research Institute Durham North Carolina USA
| |
Collapse
|
3
|
Boselli C, Cirocchi R, Gemini A, Grassi V, Avenia S, Polistena A, Sanguinetti A, Burattini MF, Pironi D, Santoro A, Tabola R, Avenia N. Surgery for colorectal cancer in elderly: a comparative analysis of risk factor in elective and urgency surgery. Aging Clin Exp Res 2017; 29:65-71. [PMID: 27837462 DOI: 10.1007/s40520-016-0642-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Colon cancer therapy is primarily surgical. Advanced age does not represent a contraindication to surgery. We analyse the results of surgery in ultra 75 patients undergoing surgery for colorectal cancer by examining the correlation between the comorbidity and any post-operative complications. MATERIALS AND METHODS We surgically treated 66 patients for colorectal cancer, aged over 75. The examined subjects were compromised for various reasons. We have evaluated the different influences of risk factors in elective and urgency operation. DISCUSSION Several studies have shown that age alone is not a significant prognostic factor in survival after colonic surgery. The assessment of general conditions in elderly patients, as demonstrated by the literature, is a fundamental moment in the management of colorectal cancer. CONCLUSIONS The surgical choice should be made case by case (custom-made), not based on age only.
Collapse
Affiliation(s)
- Carlo Boselli
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Roberto Cirocchi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy.
| | - Alessandro Gemini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Veronica Grassi
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Stefano Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Andrea Polistena
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Alessandro Sanguinetti
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| | - Maria Federica Burattini
- Department of General and Oncological Surgery, University of Perugia, Località Sant'Andrea delle Fratte, 06134, Perugia, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Alberto Santoro
- Department of Surgical Sciences, Sapienza University of Rome, Viale Regina Elena, 32400161, Rome, Italy
| | - Renata Tabola
- Department of Gastrointestinal and General Surgery, Medical University of Wrocław, Wrocław, Poland
| | - Nicola Avenia
- Department of General Surgery, Terni Saint Mary Hospital, University of Perugia, Via Tristano di Joannuccio, 05100, Terni, Italy
| |
Collapse
|
4
|
Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients - A multicentre cohort study. Eur J Surg Oncol 2016; 42:1009-17. [PMID: 27157495 DOI: 10.1016/j.ejso.2016.03.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/05/2016] [Accepted: 03/08/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nutritional status (NS), though frequently affected in onco-geriatric patients, is no standard part of a geriatric assessment. The aim of this study was to analyse the association between a preoperatively impaired NS and geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients. METHODS 309 patients ≥70 years undergoing surgery for solid tumours were prospectively recruited. Nine screening tools were preoperatively administered as part of a geriatric assessment. NS was based on BMI, weight loss and food intake. Odds ratio's (OR) and 95% confidence intervals (95% CI) were estimated using logistic regression analysis. The occurrence of 30-day adverse postoperative outcomes was recorded. RESULTS At a median age of 76 years, 107 patients (34.6%) had an impaired NS. Decreased performance status and depression were associated with an impaired NS, when adjusted for tumour characteristics and comorbidities (ORPS>1 3.46; 95% CI 1.56-7.67. ORGDS>5 2.11; 95% CI 1.05-4.26). An impaired NS was an independent predictor for major complications (OR 3.3; 95% CI 1.6-6.8). Ten out of 11 patients who deceased had an impaired NS. CONCLUSION An impaired NS is prevalent in onco-geriatric patients considered to be fit for surgery. It is associated with decreased performance status and depression. An impaired NS is a predictor for adverse postoperative outcomes. NS should be incorporated in a geriatric assessment.
Collapse
|
5
|
Selection and perioperative management of patients undergoing radical cystectomy and urinary reconstruction. Bladder Cancer 2015. [DOI: 10.1002/9781118674826.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
6
|
Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, Köhne CH, Rostoft S, Lemmens V, Mitry E, Rutten H, Sargent D, Sastre J, Seymour M, Starling N, Van Cutsem E, Aapro M. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol 2014; 26:463-76. [PMID: 25015334 DOI: 10.1093/annonc/mdu253] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Europe and worldwide, with the peak incidence in patients >70 years of age. However, as the treatment algorithms for the treatment of patients with CRC become ever more complex, it is clear that a significant percentage of older CRC patients (>70 years) are being less than optimally treated. This document provides a summary of an International Society of Geriatric Oncology (SIOG) task force meeting convened in Paris in 2013 to update the existing expert recommendations for the treatment of older (geriatric) CRC patients published in 2009 and includes overviews of the recent data on epidemiology, geriatric assessment as it relates to surgery and oncology, and the ability of older CRC patients to tolerate surgery, adjuvant chemotherapy, treatment of their metastatic disease including palliative chemotherapy with and without the use of the biologics, and finally the use of adjuvant and palliative radiotherapy in the treatment of older rectal cancer patients. An overview of each area was presented by one of the task force experts and comments invited from other task force members.
Collapse
Affiliation(s)
- D Papamichael
- Department of Medical Oncology, B.O. Cyprus Oncology Centre, Nicosia, Cyprus
| | | | - B Glimelius
- Department of Radiology, Oncology and Radiation Science, University of Uppsala, Uppsala, Sweden
| | | | | | - D Haller
- Abramson Cancer Center at the University of Pennsylvania, Philadelphia, USA
| | - C-H Köhne
- Klinikum Oldenburg, Oldenburg, Germany
| | - S Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - V Lemmens
- Erasmus MC University Medical Centre, Rotterdam Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands
| | - E Mitry
- Department of Medical Oncology, Institut Curie, Paris Université Versailles Saint-Quentin, Guyancourt, France
| | - H Rutten
- Catharina Hospital Eindhoven, Eindhoven Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - J Sastre
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, Spain
| | - M Seymour
- Cancer Medicine and Pathology, University of Leeds, Leeds
| | - N Starling
- Gastrointestinal Unit, Royal Marsden Hospital, London, UK
| | - E Van Cutsem
- Digestive Oncology, Leuven Cancer Institute, Leuven, Belgium
| | - M Aapro
- SIOG Office, Clinique de Genolier, Genolier, Switzerland
| |
Collapse
|
7
|
Abstract
There is a continuous increase in the proportion of elderly patients
undergoing surgical procedures. This review will concentrate on selected
topics related to elderly care that represent current unresolved and relevant
issues for the care of the elderly surgical patient including: aging related
organ dysfunction, perioperative risk assessment of geriatrics patient,
preoperative optimization and pharmacological support of elderly patient.
Additionally, age as a clear risk factor for postoperative cognitive
dysfunction is also discussed.
Collapse
|
8
|
Kristjansson SR, Farinella E, Gaskell S, Audisio RA. Surgical risk and post-operative complications in older unfit cancer patients. Cancer Treat Rev 2009; 35:499-502. [PMID: 19435652 DOI: 10.1016/j.ctrv.2009.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Surgeons have always dealt with elderly cancer patients, but understanding frailty and tailoring treatment is a new achievement endeavour. Mounting evidence is resulting in the introduction of geriatric assessment into clinical practice. Particularly, undernourishment should be assessed and corrected in order to avoid emergency situations whenever possible.
Collapse
Affiliation(s)
- Siri R Kristjansson
- Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway
| | | | | | | |
Collapse
|
9
|
Gosney M. General Care of the Older Cancer Patient. Clin Oncol (R Coll Radiol) 2009; 21:86-91. [DOI: 10.1016/j.clon.2008.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 10/24/2008] [Accepted: 11/17/2008] [Indexed: 01/18/2023]
|
10
|
González Montalvo JI, Alarcón Alarcón T, Pallardo Rodil B, Gotor Pérez P, Pareja Sierra T. [Acute orthogeriatric care (II). Clinical aspects]. Rev Esp Geriatr Gerontol 2008; 43:316-329. [PMID: 18842206 DOI: 10.1016/s0211-139x(08)73574-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The present article reviews the clinical principles of acute orthogeriatric care. The application of geriatric medicine to patients with hip fracture is explained. The principal stages of geriatric intervention in this process are mentioned, as are the interventions to be carried out by the geriatric team. Subsequently, we discuss the management of several frequent problems in these patients, such as high surgical risk, pain management, anaemia, delirium, malnutrition, and discharge planning. Lastly, the characteristics of several kinds of patients with special characteristics are mentioned, such as those diagnosed with dementia, nursing home residents or the oldest-old. Areas of improvement in the acute phase are also reviewed, such as mortality reduction, functional outcome improvement and the need for more efficient resource use in patients in the acute phase of hip fracture.
Collapse
|
11
|
|
12
|
Christensen S, Riis A, Nørgaard M, Sørensen HT, Thomsen RW. Short-term mortality after perforated or bleeding peptic ulcer among elderly patients: a population-based cohort study. BMC Geriatr 2007; 7:8. [PMID: 17439661 PMCID: PMC3225863 DOI: 10.1186/1471-2318-7-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 04/17/2007] [Indexed: 01/22/2023] Open
Abstract
Background Mortality after perforated and bleeding peptic ulcer increases with age. Limited data exist on how the higher burden of comorbidity among elderly patients affects this association. We aimed to examine the association of age with short-term mortality after perforated and bleeding peptic ulcer and to determine the impact of comorbidity on this association. Methods In this population-based cohort study in three Danish counties between 1991 and 2003 we identified two cohorts of patients: those hospitalized with a first-time discharge diagnosis of perforated peptic ulcer and those with bleeding peptic ulcer. The diagnoses were ascertained from hospital discharge registries and mortality through the Danish Civil Registration System. Information on comorbidity and use of ulcer-related drugs was obtained through administrative medical databases. We computed age-, gender- and comorbidity-standardized 30-day mortality rates and used Cox's regression to estimate adjusted 30-day mortality rate ratios (MRR) for elderly compared with younger patients. Results Among 2,061 patients with perforated peptic ulcer, 743 (36%) were 65–79 years old and 513 patients (25%) were aged 80+ years. Standardized 30-day mortality was 8.9% among patients younger than 65 years rising to 44.6% among patients aged 80+ years, corresponding to an adjusted MRR of 5.3 (95% CI: 4.0–7.0). Among 7,232 patients with bleeding peptic ulcer 2,372 (33%) were aged 80+ years. Standardized 30-day mortality among patients younger than 65 was 4.3% compared with 16.9% among patients aged 80+ years, corresponding to an adjusted MRR of 3.7 (95% CI: 2.9–4.7). Analyses stratified by comorbidity consistently showed high MRRs among elderly patients, regardless of comorbidity level. Conclusion Ageing is a strong predictor for a poor outcome after perforated and bleeding peptic ulcer independently of comorbidity.
Collapse
Affiliation(s)
- Steffen Christensen
- Department of Clinical Epidemiology, Aalborg and Aarhus Hospital, Aarhus University Hospital, Denmark
| | - Anders Riis
- Department of Clinical Epidemiology, Aalborg and Aarhus Hospital, Aarhus University Hospital, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aalborg and Aarhus Hospital, Aarhus University Hospital, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aalborg and Aarhus Hospital, Aarhus University Hospital, Denmark
- Department of Epidemiology, School of Public Health, Boston University, MA, USA
- Department of Medicine V, Aarhus University Hospital, Denmark
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aalborg and Aarhus Hospital, Aarhus University Hospital, Denmark
| |
Collapse
|
13
|
Audisio RA, Ramesh H, Longo WE, Zbar AP, Pope D. Preoperative Assessment of Surgical Risk in Oncogeriatric Patients. Oncologist 2005; 10:262-8. [PMID: 15821246 DOI: 10.1634/theoncologist.10-4-262] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cancer is a prevalent disease in our aging population; however, few oncologists are familiar with caring for oncogeriatric patients. Surgery is presently the treatment of choice for most solid tumors, but it is frequently delivered in a suboptimal way in this patient subsetting. Undertreatment is often justified with the concern of an unsustainable toxicity, while overtreatment can be related to the lack of knowledge in optimizing preoperative risk assessment. To draw new light on this issue, several surgeons presented their series, providing hard evidence that surgical options can be offered to the elderly with cancer, with only a limited postoperative mortality and morbidity. As it is likely that much of these data suffer from selection bias, we concentrated on Comprehensive Geriatric Assessment (CGA), which can add substantial information on the functional assessment of elderly cancer patients. A validated instrument such as the CGA allows a comparison of series, predicting short-term surgical outcomes more precisely, and offers appropriate information when consenting elderly patients. Preoperative Assessment of Cancer in the Elderly is a prospective international study conceived and launched to outline the fitness of elderly surgical patients with malignant tumors. This paper reports on preliminary results and analysis from the ongoing study.
Collapse
|
14
|
|
15
|
Edwards JSA, Hartwell HJ. A comparison of energy intake between eating positions in a NHS hospital—a pilot study. Appetite 2004; 43:323-5. [PMID: 15527937 DOI: 10.1016/j.appet.2004.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2004] [Accepted: 06/10/2004] [Indexed: 11/28/2022]
Abstract
Malnutrition and the under-consumption of food in hospitals is prevalent and in UK hospitals, the consumption of meals is mainly a solitude event, despite evidence to show that eating in the presence of others can actually increase food intake. Dietary data were collected for three consecutive 24 h periods (n=13) from patients who consumed their meals either in bed, at the side of the bed or in the presence of others. Results show a significant increase (p<0.05) in the mean daily energy intake for those sitting around a table in the presence of others. Although a small pilot study, the results confirm the value of social facilitation in improving the under-consumption of food when in hospital.
Collapse
Affiliation(s)
- J S A Edwards
- Worshipful Company of Cooks Research Centre, Bournemouth University, Poole, Dorset BH12 5BB, England.
| | | |
Collapse
|
16
|
Audisio RA, Bozzetti F, Gennari R, Jaklitsch MT, Koperna T, Longo WE, Wiggers T, Zbar AP. The surgical management of elderly cancer patients. Eur J Cancer 2004; 40:926-38. [PMID: 15093567 DOI: 10.1016/j.ejca.2004.01.016] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 01/19/2004] [Indexed: 12/13/2022]
Abstract
Although cancer in the elderly is extremely common, few health professionals in oncology are familiar with caring for series of oncogeriatric patients. Surgery is at present the first choice, but is frequently delivered suboptimally: under-treatment is justified by concerns about unsustainable toxicity, whilst over-treatment is explained by the lack of knowledge in optimising preoperative risk assessment. This article summarises the point of view of the Surgical Task Force @ SIOG (International Society for Geriatric Oncology), pointing out differences from, and similarities to, the younger cohorts of cancer patients, and highlighting the latest updates and trends specifically related to senior cancer patients.
Collapse
Affiliation(s)
- R A Audisio
- University of Liverpool, Whiston Hospital, Prescot, UK.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Bozzetti F. Operative risk of rectal cancer surgery in the elderly. Am J Surg 2004; 187:150-1; author reply 151. [PMID: 14706612 DOI: 10.1016/j.amjsurg.2003.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
18
|
Abstract
Aging is associated with a progressive decline in the function of many organs and apparatus. In a medical context, depletion of lean body mass and muscle mass in particular, and alteration of the immune system are of utmost importance. A defective immune response is associated with an increased incidence of inflammatory, infective and neoplastic diseases in the elderly as well as with a slow and sluggish recovery after illness or other injury. Depletion of muscle mass, the so-called sarcopenia, is responsible for the typical frailty of the elderly. Moreover, since muscle represents the protein reserve of the body, its progressive erosion not only results in a poor mobility and disability of these subjects, with associated complications, but with a diminished capacity to meet the extra demand of protein synthesis associated with disease and injury. In cancer patients, as in other elderly patients with different pathologies, it is important to evaluate the nutritional status, since frailty of these individuals recognizes as a relevant etiopathogenetic cofactor, a defective food intake. Nutritional support should aim at meeting the requirements in macronutrients, in water and in micronutrients. Requirements are not so different from those of adult subjects, since the decrease in energy expenditure due to a lower physical activity is compensated by the increase due to the disease. Particular attention must be given to fluid administration, since the elderly tolerate fluid overload less than hypohydration. Elderly patients quite frequently suffer from long-standing undernutrition; this means that nutritional repletion will take more time than is usually expected with use of medication. If a correct feeding program is performed for a few weeks, a benefit can be observed not only on the nutritional status but also in the clinical outcome. In fact nutritional support may have a permissive role in the administration of aggressive (oncologic) treatment than may be otherwise denied to elderly patients.
Collapse
Affiliation(s)
- Federico Bozzetti
- Istituto Nazionale per lo Studio e la Cura dei Tumori, Via G. Venezian 1, 20133 Milan, Italy.
| |
Collapse
|
19
|
Audisio RA, Gennari R, Sunouchi K, Nair HR, Sestini A, Pope D, West C. Preoperative Assessment of Cancer in Elderly Patients: A Pilot Study. ACTA ACUST UNITED AC 2003; 1:55-60. [DOI: 10.3816/sct.2003.n.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Hartmann A, Pile-Spellman J, Stapf C, Sciacca RR, Faulstich A, Mohr JP, Schumacher HC, Mast H. Risk of endovascular treatment of brain arteriovenous malformations. Stroke 2002; 33:1816-20. [PMID: 12105359 DOI: 10.1161/01.str.0000020123.80940.b2] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Independently assessed data on frequency, severity, and determinants of neurological deficits after endovascular treatment of brain arteriovenous malformations (AVMs) are scarce. METHODS From the prospective Columbia AVM Study Project, 233 consecutive patients with brain AVM receiving > or =1 endovascular treatments were analyzed. Neurological impairment was assessed by a neurologist using the Rankin Scale before and after completed endovascular therapy. Multivariate logistic regression models were used to identify demographic, clinical, and morphological predictors of treatment-related neurological deficits. The analysis included the components used in the Spetzler-Martin risk score for AVM surgery (AVM size, venous drainage pattern, and eloquence of AVM location). RESULTS The 233 patients were treated with 545 endovascular procedures. Mean follow-up time was 9.6 months (SD, 18.1 months). Two hundred patients (86%) experienced no change in neurological status after treatment, and 33 patients (14%) showed treatment-related neurological deficits. Of the latter, 5 (2%) had persistent disabling deficits (Rankin score >2), and 2 (1%) died. Increasing patient age [odds ratio (OR), 1.04; 95% confidence interval (CI), 1.01 to 1.08], number of embolizations (OR, 1.41; 95% CI, 1.16 to 1.70), and absence of a pretreatment neurological deficit (OR, 4.55; 95% CI, 1.03 to 20.0) were associated with new neurological deficits. None of the morphological AVM characteristics tested predicted treatment complications. CONCLUSIONS From independent neurological assessment and prospective data collection, our findings suggest a low rate of disabling treatment complications in this center for endovascular brain AVM treatment. Risk predictors for endovascular treatment differ from those for AVM surgery.
Collapse
Affiliation(s)
- A Hartmann
- Stroke Center, Neurological Institute, New York Presbyterian Hospital, New York, NY, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- C R Pennington
- Department of Gastroenterology and Clinical Nutrition, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| |
Collapse
|