Operative morbidity and mortality in octogenarians and nonagenarians with ovarian cancer.

Abstract

Listen

Translate article

5070 Background: The decision to choose aggressive cytoreduction versus neoadjuvant chemotherapy in patients with newly diagnosed ovarian cancer is often influenced by age and medical comorbidities. We sought to compare perioperative morbidity and mortality of patients age >/= 80 compared to younger patients. Methods: After IRB approval was obtained, a retrospective chart review was conducted evaluating patients that underwent surgical cytoreduction for ovarian or peritoneal cancer between 1/05 and 12/09. Patients were divided into two cohorts (<age 80, and >/= age 80). Patient demographics, surgical procedures, readmission rates, length of stay (LOS), 30 day mortality rates, and chemotherapy administration were examined. Student’s t test and chi square test were used to evaluate statistical significance. Results: 384 patients that underwent surgical debulking for ovarian cancer were identified. 352 (91.7%) patients were <80yo, while 32 (8.3%) patients were >/= 80yo. Amongst the younger cohort, 236 (67.0%) were optimally cytoreduced compared to 17 (53.1%) in the older cohort (p=0.12). Patients in the older cohort had more medical comorbidities (1.7 v 1.2, p=0.03). Thirty day readmission rates were similar between the two cohorts; 14.5% for the younger cohort versus 15.6% for the older cohort (p=0.80). Post-operative complication rates were also similar (45.2% v 53.1%, p=0.46). More patients in the older cohort required preoperative admission for medical clearance (50.0% v 18.7%, p<0.01). Mean LOS was significantly longer in the older cohort (10.0 days v 7.5 days, p=0.02). The number of patients that received adjuvant chemotherapy was significantly lower in the older cohort (71.9% v 93.8%, p<0.01). The 30 day mortality rate was significantly higher in the older cohort (18.8% v 4.0%, p<0.01). Older patients with two or more medical comorbidities had a 30 day mortality rate of 31.3%. Conclusions: Although octogenarians who undergo surgical debulking have similar complication rates as their younger counterparts, they will require more medical clearance and have a longer hospital stay. Older patients are less likely to undergo chemotherapy and have a higher 30 day mortality rate than younger patients.