ObjectiveTo compare the long-term survival of elderly patients with esophageal squamous cell carcinoma (ESCC) treated with surgical versus non-surgical treatment. MethodsA retrospective analysis was conducted on the clinical data of elderly patients aged ≥70 years with ESCC who underwent esophagectomy or radiotherapy/chemotherapy at Sichuan Cancer Hospital from January 2009 to September 2017. Patients were divided into a surgical group (S group) and a non-surgical group (NS group) according to the treatment method. The propensity score matching method was used to match the two groups of patients at a ratio of 1∶1, and the survival of the two groups before and after matching was analyzed. ResultsA total of 726 elderly patients with ESCC were included, including 552 males and 174 females, with 651 patients aged ≥70-80 years and 75 patients aged ≥80-90 years. There were 515 patients in the S group and 211 patients in the NS group. The median follow-up time was 60.8 months, and the median overall survival of the S group was 41.9 months [95%CI (35.2, 48.5)], while that of the NS group was only 24.0 months [95%CI (19.8, 28.3)]. The 1-, 3-, and 5-year overall survival rates of the S group were 84%, 54%, and 40%, respectively, while those of the NS group were 72%, 40%, and 30%, respectively [HR=0.689, 95%CI (0.559, 0.849), P<0.001]. After matching, 138 patients were included in each group, and there was no statistical difference in the overall survival between the two groups [HR=0.871, 95%CI (0.649, 1.167), P=0.352]. ConclusionCompared with conservative treatment, there is no significant difference in the long-term survival of elderly patients aged ≥70 years who undergo esophagectomy for ESCC. Neoadjuvant therapy combined with surgery is still an important choice to potentially improve the survival of elderly patients with ESCC.
Esophageal cancer (EC) is the eighth dangerous cancer in the world. As the global population ages, the management of elderly patients with EC poses a challenge as they have many aging-associated diseases and physiological changes. In addition, the data on the tolerability of cancer treatment and the use of combined therapies in the patients to guide their treatment are limited. In this paper, we reviewed the literatures and discussed the effect of surgical resection and the potential complications of elderly patients. We reviewed the basic principles of combined therapy and the potential benefits of chemotherapy or chemoradiotherapy for patients and focused on the management of elderly patients with EC as well as the role of comprehensive assessment for aging to provide treatment options for elderly patients.
Objective To summarize the selection criteria and clinical application of surgical methods for hip fractures (femoral neck fracture and intertrochanteric fracture) in the elderly. Methods The related literature concerning the surgical methods for femoral neck fracture and intertrochanteric fracture in the elderly at home and abroad was extensively reviewed and summarized. Results Among the elderly patients with femoral neck fracture, the closed reduction and internal fixation or dynamic hip screw (DHS), and total hip arthroplasty are recommended for patients under 65 years old and 65–80 years old respectively and without special surgical contraindication; whereas hemiarthroplasty is recommended for patients with poor physical conditions. Among the patients with intertrochanteric fracture, DHS or the 3rd generation of Gamma nails is recommended for patients with stable fracture while the intramedullary fixation systems (e.g., proximal femoral nail anti-rotation, intertrochanteric antegrade nail) and the extramedullary fixation systems (e.g., proximal femoral locking compression plate and less invasive stabilization system) can be applied to the patients with unstable fracture according to the fracture type and bone conditions. Notably, hip arthroplasty is recommended for elderly patients with comminuted fracture. Conclusion The surgical method and internal fixator should be chosen according to the fracture type and bone condition in the elderly in order to improve the effectiveness and reduce the complication.
Objective To compare the effectiveness of internal fixation, hemiarthroplasty, and total hip arthroplasty in the treatment of displaced femoral neck fractures in elderly patients so as to provide the evidence for the selection of therapeutic methods. Methods Between May 2005 and April 2008, 108 elderly patients with displaced femoral neck fractures were treated by internal fixation with compression screw (IF group, n=31), hemiarthroplasty (HA group, n=37), and total hiparthroplasty (THA group, n=40). In IF group, there were 8 males and 23 females with an average age of 73 years (range, 65-80 years); fractures were caused by tumbl ing (25 cases) and traffic accident (6 cases), including 17 cases of Garden type III and 14 cases of Garden type IV; and the time from injury to operation ranged from 8 hours to 13 days with an average of 4.2 days. In HA group, there were 10 males and 27 females with an average age of 74 years (range, 65-80 years); fractures were caused by tumbl ing (29 cases) and traffic accident (8 cases), including 21 cases of Garden type III and 16 cases of Garden type IV; and the time from injury to operation ranged from 1 to 14 days with an average of 4.4 days. In THA group, there were 11 males and 29 females with an average age of 73 years (range, 66-80 years); fractures were caused by tumbl ing (32 cases) and traffic accident (8 cases), including 23 cases of Garden type III and 17 cases of Garden type IV; and the time from injury to operation ranged from 2 to 14 days with an average of 5.6 days. There was no significant difference in general data among 3 groups (P gt; 0.05). Results There were significant differences in operation time and blood loss among 3 groups (P lt; 0.05), and IF group was less than other 2 groups. All patients were followed up 1 year and 4 months to 2 years and 3 months with an average of 1 year and 8 months. In IF group, HA group, and THA group, the rates of early postoperative compl ications were 19.4% (6/31), 8.1% (3/37), and 7.5% (3/40), respectively; the rates of late postoperative compl ications were 29.0% (9/31), 13.5% (5/37), and 7.5% (3/40), respectively; and the reoperation rates were 29.0% (9/31), 10.8% (4/37), and 5.0% (2/40), respectively. The rates of the early postoperative compl ication, late postoperative compl ication, and reoperation rate were significantly higher in IF group than in HA group and THA group (P lt; 0.05), but there was no significant difference between HA group and THA group (P gt; 0.05). The mortal ity rates were 16.1% (5/31), 13.5% (5/37), and 15.0% (6/40) in IF group, HA group, and THA group, respectively; showing no significant difference (P gt; 0.05). According to Harris hip score, the excellent and good rates were 65.4% (17/26), 81.3% (26/32), and 85.3% (29/34) in IF group, HA group, and THA group, respectively; showing significant differences among 3 groups (P lt; 0.05). Conclusion According to patient’s age, l ife expectancy, and general conditions, THA is a reasonable choice for the patients aged 65-80 years with displaced femoral neck fracture.
Objective To investigate the expression and clinical significance of T lymphocyte subsets, natural killer (NK) cells and CD19+ B cells in the elderly with primary immune thrombocytopenia (ITP) before and after treatment. Methods The elderly ITP patients diagnosed and treated in the Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (preparatory stage) between January 2014 and June 2019 were retrospectively selected as the observation group. The healthy elderly in the same period were selected as the control group. According to the treatment, the observation group was divided into effective group and ineffective group. The expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+/CD8+), NK cells and CD19+ B cells were observed and analyzed. Results A total of 75 subjects were included, including 35 in the observation group and 40 in the control group. The total effective rate was 85.71% (30/35). Before treatment, the expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the observation group were lower than those in the control group (P<0.05). There was no significant difference in other indexes between the two groups (P>0.05). After treatment, except for CD8+, the expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the observation group were higher than those before treatment (P<0.05). The expression levels of NK cells and CD19+ B cells were lower than those before treatment (P<0.05). The expression levels of T lymphocyte subsets (CD3+, CD4+ and CD4+/CD8+) in the effective group were higher than those before treatment (P<0.05), while the expression level of CD19+ B cells was lower than that before treatment (P<0.05). There was no significant difference in other indexes before and after treatment (P>0.05). There was no significant difference in the expression levels of T lymphocyte subsets (CD3+, CD4+, CD8+ and CD4+/CD8+), NK cells and CD19+ B cells in the ineffective group before and after treatment (P>0.05). Conclusions T lymphocyte subsets are abnormal in elderly ITP patients. The immune abnormality of T lymphocyte may be one of the reasons for elderly patients with ITP. With the improvement of therapeutic effect, immune cell subsets have also been improved.
Objective To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups. Results Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 hvs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 dvs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 mlvs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9%vs. 23.1%, P<0.05). Conclusion The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.
ObjectiveTo investigate the value of chest high-resolution computed tomography (HRCT) score in evaluating the severity of hip fracture-induced early acute lung injury (ALI) in the elderly patients.MethodsThe clinical data of 289 elderly hip fracture patients in Chongqing Traditional Chinese Medicine Hospital from July 2014 to April 2020 were retrospectively analyzed. All patients were divided into two groups, including an ALI group (n=114, 36 males and 78 females at age of 82.94±6.85 years) and a non-ALI group (n=175, 51 males and 124 females at age of 84.42±6.31 years). General information, chest HRCT scores and PaO2/FiO2 were compared between the two groups. Correlation analysis was used to compare the relationship between chest HRCT scores and PaO2/FiO2. Multiple linear stepwise regression analysis was applied to evaluate the effective extent of the diffuse ground glass opacity (DGGO), intense parenchymal opacification (IPO), and reticulation HRCT scores to the overall HRCT scores.ResultsThe DGGO scores, IPO scores, reticulation scores, overall HRCT scores and PaO2/FiO2 were higher in the ALI group than those in the non-ALI group (P<0.001). In the ALI group, correlation analysis showed that DGGO, overall HRCT scores were in significantly negative correlation with PaO2/FiO2 (P<0.001). In addition, the correlation among PaO2/FiO2 and overall HRCT scores was more significant than that of DGGO scores. Multiple stepwise regression analysis indicated that DGGO, IPO, and reticulation scores were independent influencing factors for overall HRCT scores. Among the influencing factors, DGGO scores had the greatest impact, then IPO scores and reticulation scores. The HRCT signs of DGGO, IPO, and reticulation appeared simultaneously had the greatest effects on the overall HRCT scores.ConclusionThe chest HRCT score, which is associated with PaO2/FiO2, also can be used in the severity assessment of elderly patients with early ALI caused by hip fracture.
ObjectiveTo investigate the clinical effect and prognosis of laparoscopic complete mesocolic resection (CME) in the treatment of elderly patients with stage Ⅲ right colon cancer.MethodsClinical data of 280 elderly patients (aged 60 years or older) who underwent stage Ⅲ right hemicolectomy in the First Hospital of Lanzhou University from 2010 to 2015 were collected. Among them, 160 patients underwent laparoscopic CME treatment were set as the observation group, and 120 patients underwent conventional laparotomy were set as the control group. The mean operative time, intraoperative blood loss, postoperative first anal exhaust time, number of lymph nodes dissection, number of positive lymph nodes, length of hospital stay and postoperative complications were compared between the two groups. The postoperative local recurrence rate, distant metastasis rate, 3-year cumulative survival rate and postoperative recurrence risk factors were analyzed.ResultsThere were no statistically significant differences between the observation group and the control group in operative time, number of lymph node dissection, number of positive lymph nodes and postoperative distant metastasis rate (P>0.05). The amount of intraoperative blood loss, postoperative anal first exhaust time, days of hospitalization, and postoperative recurrence rate in the observation group were less or shorter or lower than those in the control group, with statistically significant differences (P<0.05). The 3-year survival rate in the observation group was higher than that in the control group (log-rank χ2 =11.865, P=0.001), and the disease free survival in the observation group was also higher than that in the control group (log-rank χ2=7.567, P=0.006). Logistic regression was used to analyze the cases of postoperative recurrence in the two groups, and it was found that the degree of tumor differentiation, vascular invasion and lymph node metastasis were independent risk factors for postoperative tumor recurrence.ConclusionLaparoscopic CME in the treatment of elderly patients with stage Ⅲ right colon cancer is effective, it is safe and feasible, which can effectively prolong the survival time of patients.
ObjectiveTo evaluate the feasibility and safety of da Vinci robotic surgery for elderly patients with radical surgery of lung cancer.MethodsWe retrospectively analyzed the clinical data of 59 patients aged over 70 years who underwent radical surgery of lung cancer in our hospital between 2016 and 2019. These patients were divided into two groups including a da Vinci robot group and a single-utility port video-assisted thoracoscopic surgery (VATS) group according to the patients’ selection of the treatments. There were 32 patients with 20 males and 12 females aged 73.1±2.3 years in the da Vinci robot group and 27 patients with 16 males and 11 females aged 71.2±1.3 years in the VATS group. The clinical data of the two groups were compared.ResultsThere was no statistical difference in surgery time between the two groups (t=–0.341, P=0.484). Compared with the VATS group, the da Vinci robot group had more number of lymph nodes dissected (t=1.635, P=0.015), less intraoperative blood loss (t=–2.569, P <0.001), less postoperative drainage amount within 3 days after surgery (t=–6.325, P=0.045), lower visual analogue scale (VAS) scores at postoperative 3rd day (t=–7.214, P=0.021).ConclusionThe da Vinci robot system is safe and efficient in the treatment for elderly patients with radical surgery of lung cancer with less trauma.
ObjectiveTo explore the predictive value of the modified frailty index-11 (mFI-11) for postoperative complications in elderly lung cancer patients undergoing robot-assisted lobectomy. MethodsRetrospective collection of clinical data from lung cancer patients aged ≥65 years who underwent robot-assisted lobectomy at the Department of Thoracic Surgery, Gansu Provincial Hospital, from January 2022 to June 2025. Based on the optimal grouping threshold of 0.27 in previous studies for the mFI-11 score, patients were divided into a frail and a non-frail group. Postoperative complications of the two groups were analyzed, and multivariate logistic regression was used to assess the relationship between mFI-11 and postoperative complications. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficiency of mFI-11 for postoperative complications. ResultsA total of 161 patients were included, with 77 males and 84 females, and an average age of (68.48±2.90) years. Among them, 103 (64.0%) patients were in the non-frail group and 58 (36%) in the frail group. Differences between the two groups in terms of independent functional status, hypertension requiring drug control, history of type 2 diabetes, history of chronic obstructive pulmonary disease, American Society of Anesthesiologists classification, and tumor staging were all statistically significant (P<0.05). The length of postoperative hospital stay in the frail group was longer than that in the non-frail group [5.50 (5.00, 8.25) d vs. 5.00 (4.00, 5.00) d, P<0.001]. The incidence rates of general respiratory diseases (25.9% vs. 8.7%), hypoproteinemia (15.5% vs. 4.9%), arrhythmia (12.1% vs. 1.9%), bronchopleural fistula (5.2% vs. 0.0%), transfer to ICU for severe complications (10.3% vs. 1.0%), and readmission within 30 days after discharge (12.1% vs. 1.9%) were all higher in the frail group compared to the non-frail group (P<0.05). Multivariate logistic regression analysis found that mFI-11 had a better predictive efficiency for postoperative complications: general respiratory diseases [area under the curve (AUC)=0.759], hypoproteinemia (AUC=0.723), arrhythmia (AUC=0.795), transfer to ICU for severe complications (AUC=0.713), and readmission within 30 days after discharge (AUC=0.702). ConclusionmFI-11 can effectively predict postoperative complications in elderly lung cancer patients undergoing robot-assisted lobectomy and can serve as an objective indicator for identifying high-risk elderly lung cancer patients.