Advertisement

Super-elderly patient-specific perioperative complications in breast cancer surgery

  • Yoshinari OgawaEmail author
  • Katsumi Ikeda
  • Chika Watanabe
  • Yuri Kamei
  • Wataru Goto
  • Chika Shiraishi
  • Shinya Tokunaga
  • Yuko Tsuboguchi
Original Article

Abstract

Purpose

Geriatric surgery poses specific challenges due to patient vulnerability in relation to aging. We analyzed perioperative challenges concerning super-elderly patients with breast cancer.

Methods

Between 2013 and 2018, 908 patients with breast cancer were treated surgically. Of these, two patient groups were compared: Group A (≥ 85 years old, n = 34, 3.7%) and Group B (75–84 years old, n = 136, 15%).

Results

In Groups A and B, 26.4% and 36.8% of patients lived alone, respectively. Group A patients had higher rates of psychiatric and cardiovascular disease (32.4% and 41.2%) than Group B (8.8% and 16.2%) (p = 0.0009 and p = 0.0031, respectively). There was no marked difference in the type of surgery or length of hospital stay between groups, and most complications involved surgical site disorders. Postoperatively, Group A had a higher rate of delirium (29.4%) than Group B (3.7%) (p < 0.0001). The 30-day postoperative mortality rate was 0, and 76.5% of Group A and 45.6% of Group B patients received no adjuvant therapy (p = 0.0024).

Conclusions

Age alone does not constitute a contraindication for appropriate surgery, although there are some challenges necessary to consider for super-elderly patients.

Keywords

Breast Elderly Surgery Complication Delirium 

Notes

Funding

No grant was received for this study.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

This study was approved by the Ethics Committee of Osaka City General Hospital (December 2018; No.1812103).

References

  1. 1.
    Ministry of Health, Labour and Welfare Japan (in Japanese). https://www.mhlw.go.jp/toukei/saikin/hw/life/life17/dl/life17-02.pdf
  2. 2.
    National Cancer Center Japan (in Japanese). gdb.ganjoho.jp/grph_db/gadb1?smTypes=14Google Scholar
  3. 3.
    Evron E, Goldberg H, Kuzmin A, Gutman R, Rizel S, Sella A, et al. Breast cancer in octogenarians. Cancer. 2006;106:1664–8.CrossRefGoogle Scholar
  4. 4.
    Rao VS, Jameel JK, Mahapatra TK, McManus PL, Fox JN, Drew PJ. Surgery is associated with lower morbidity and longer survival in elderly breast cancer patients over 80. Breast J. 2007;13:368–73.CrossRefGoogle Scholar
  5. 5.
    Lavelle K, Todd C, Moran A, Howell A, Bundred N, Campbell M. Non-standard management of breast cancer increases with age in the UK: a population based cohort of women %3e or =65 years. Br J Cancer. 2007;96:1197–203.CrossRefGoogle Scholar
  6. 6.
    Bastiaannet E, Liefers GJ, de Craen AJ, Kuppen PJ, van de Water W, Portielje JE, et al. Breast cancer in elderly compared to younger patients in the Netherlands: stage at diagnosis, treatment and survival in 127,805 unselected patients. Breast Cancer Res Treat. 2010;124:801–7.CrossRefGoogle Scholar
  7. 7.
    Hind D, Wyld L, Beverley CB, Reed MW. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev. 2006;5:CD004272.Google Scholar
  8. 8.
    Kantor O, Pesce C, Liederbach E, Wang CH, Winchester DJ, Yao K. Surgery and hormone therapy trends in octogenarians with invasive breast cancer. Am J Surg. 2016;211:541–5.CrossRefGoogle Scholar
  9. 9.
    Punglia RS, Morrow M, Winer EP, Harris JR. Local therapy and survival in breast cancer. N Engl J Med. 2007;356:2399–405.CrossRefGoogle Scholar
  10. 10.
    Chatzidaki P, Mellos C, Briese V, Mylonas I. Perioperative complications of breast cancer surgery in elderly women (≥80 years). Ann Surg Oncol. 2011;18:923–31.CrossRefGoogle Scholar
  11. 11.
    de Glas NA, Kiderlen M, Bastiaannet E, de Craen AJM, van de Water W, van de Velde CJH, et al. Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis. Breast Cancer Res Treat. 2013;138:561–9.CrossRefGoogle Scholar
  12. 12.
    Petteke E, Ilonzo N, Ayewah M, Tsantes S, Estabrook A, Ma AMT. Short-term, postoperative breast cancer outcomes in patients with advanced age. Am J Surg. 2016;212:677–81.CrossRefGoogle Scholar
  13. 13.
    Angarita FA, Acuna SA, Cordeiro E, Elnahas A, Sutradhar S, Jackson T, et al. Thirty-day postoperative morbidity and mortality in elderly women with breast cancer: an analysis of the NSQIP database. Breast Cancer Res Treat. 2018;170:373–9.CrossRefGoogle Scholar
  14. 14.
    Buchner DM, Wagner EH. Preventing frail health. Clin Geriatr Med. 1992;8:1–17.CrossRefGoogle Scholar
  15. 15.
    Fried LP, Tanger CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:146–56.CrossRefGoogle Scholar
  16. 16.
  17. 17.
    8th Edition of the UICC TNM classification of Malignant Tumors. In: Japanese Breast Cancer Society. General Rules for Clinical and Pathological Recording of Breast Cancer, 1th edn. Tokyo: Kanehara-shuppan; 201. 103–109.Google Scholar
  18. 18.
    Schuurmans MJ, Shortridge-Baggett LM, Duursma SA. The delirium observation screening scale: a screening instrument for delirium. Res Theory Nurs Pract. 2003;17:31–50.CrossRefGoogle Scholar
  19. 19.
    Land LH, Dalton SO, Jensen MB, Ewertz M. Impact of comorbidity on mortality: a cohort study of 62,591 Danish women diagnosed with early breast cancer. 1990–2008.Google Scholar
  20. 20.
    Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst. 2011;103:1101–11.CrossRefGoogle Scholar
  21. 21.
    GDB 2016 Dementia Collaborators. Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:88–106.Google Scholar
  22. 22.
    Gajdos C, Kile D, Hawn MT, Finlayson E, Henderson WG, Robinson TN. Advancing age and 30-day adverse outcomes after nonemergent general surgeries. J Am Geriatr Soc. 2013;61:1608–14.CrossRefGoogle Scholar
  23. 23.
    Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. Br J Anaesth. 2009;103(1):41–6.CrossRefGoogle Scholar
  24. 24.
    Raats JW, van Eijsden WA, Crolla RMPH, Steyerberg EW, van der Laan L. Risk factors and outcomes for postoperative delirium after major surgery in elderly patients. PLoS One. 2015;10:e136071.CrossRefGoogle Scholar
  25. 25.
    Inouye SK, Bogardus ST, Charpentier PA, LEO-Summers L, Acampora D, Holford TR, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999;340:669–76.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Yoshinari Ogawa
    • 1
    Email author
  • Katsumi Ikeda
    • 1
  • Chika Watanabe
    • 1
  • Yuri Kamei
    • 1
  • Wataru Goto
    • 1
  • Chika Shiraishi
    • 2
  • Shinya Tokunaga
    • 3
  • Yuko Tsuboguchi
    • 3
  1. 1.Department of Breast Surgical OncologyOsaka City General HospitalOsakaJapan
  2. 2.Palliative Care UnitOsaka City General HospitalOsakaJapan
  3. 3.Department of Medical OncologyOsaka City General HospitalOsakaJapan

Personalised recommendations