Surgery in the Older Patient

ABSTRACT: Surgery is still the most important treatment for solid tumors, regardless of the age of the patient. In this article, we discuss the physiology of aging as it relates to risk assessment in the elderly surgical oncology patient. A brief review of the role of surgery in the treatment of breast, colorectal, pancreatic, and gastric cancer is provided, because these solid tumors primarily affect elderly patients. Options for palliation are discussed. We conclude that older patients should not be deprived of curative surgery based on chronologic age alone. [ONCOLOGY 16:183-199, 2002]

The population of the United States is growing and aging. Because the incidence of cancer, particularly solid tumors, increases with age, the number of elderly patients with cancer who require surgical intervention is expected to rise markedly in the next decade. Surgery remains the most important treatment for solid tumors, regardless of the patient’s age. In hematologic malignancies such as lymphoma and leukemia, surgery is often required for diagnosis and consolidation of treatment. The most common tumors in elderly patients-colorectal, breast, gastric, and pancreatic cancer-require surgery for cure.

Because clinicians often underestimate the life expectancy of elderly patients, cancer in these patients is frequently undertreated. Inadequate initial therapy for an older cancer patient can result in recurrence, metastasis, or death. Not only are these outcomes potentially preventable with appropriate intervention, they can also have a severe impact on the quality of life of the elderly patient, in whom preservation of quality of life is paramount.

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