Geriatric co-management leads to safely performed cytoreductive surgery in older women with advanced stage ovarian cancer treated at a tertiary care cancer center.
Gynecol Oncol
; 154(1): 77-82, 2019 07.
Article
em En
| MEDLINE
| ID: mdl-31078241
ABSTRACT
OBJECTIVE:
To assess fitness and outcomes in older women undergoing cytoreductive surgery for advanced ovarian cancer (OC).METHODS:
A prospective study of OC patients referred to Geriatrics Clinic for preoperative evaluation. All completed the electronic Rapid Fitness Assessment (eRFA) and were followed by Geriatrics Service during inpatient postoperative course, co-managed by Surgical Service. Outcomes were 30-day Intensive Care Unit (ICU) admission, emergency room (ER) visit, readmission, mortality, adverse surgical events. Descriptive statistics were used.RESULTS:
Forty-two women (median age 79, range 74-88), 38 with newly diagnosed advanced OC, 4 with recurrent OC, underwent cytoreductive surgery between 5/2015 and 1/2018. Preoperative age-related impairments per eRFA high level of distress (71%), functional dependency (59%), limited social activity (59%), depression (57%), slow Time Up and Go (54%), Karnofsky Performance Score (KPS)â¯≤â¯80 (41%), poor social support (43%), polypharmacy (35%), weight loss>10 lbs. (25%), fall history (244%), cognitive impairment (13%). Median number of comorbid conditionsâ¯=â¯3. Among 38 newly diagnosed women, 26 (68%) had stage IIIC, 11 (29%) stage IV. Sixteen (42%) underwent primary debulking surgery, 22 (58%) neoadjuvant chemotherapy followed by interval debulking surgery. Median duration of surgeryâ¯=â¯245.5â¯min (range 95-621); median hospital length of stayâ¯=â¯6â¯days (range 0-22). Optimal debulking rateâ¯=â¯97%, complete gross resection rateâ¯=â¯63%. One patient was admitted to ICU, 26% had 30-day ER visit, 10% were readmitted. Any complication, minor complication, major complication occurred in 58%, 55%, 8%, respectively. Median time from surgery to postoperative chemotherapyâ¯=â¯34.5â¯days (range 19-66). Median follow-upâ¯=â¯15.7â¯months (range 3.7-38.0), 12-month survivalâ¯=â¯93.3%. There was no 180-day mortality.CONCLUSION:
Cytoreductive surgery among older women with advanced OC and frailty can be performed safely in a tertiary care center with preoperative/postoperative geriatric and surgical co-management.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias Ovarianas
/
Procedimentos Cirúrgicos de Citorredução
/
Geriatria
Tipo de estudo:
Observational_studies
Limite:
Aged
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Aged80
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Female
/
Humans
Idioma:
En
Revista:
Gynecol Oncol
Ano de publicação:
2019
Tipo de documento:
Article