Contraindication For Surgery Research Articles

Risk Factors for Postoperative Complications among the Elderly after Plastic Surgery Procedures Performed under General Anesthesia.

Background The frequency of surgery involving elderly patients has been increasing. The use of free tissue transfers in the elderly has been examined previously (Howard et al., 2005, Hwang et al., 2016, Grammatica et al., 2015, Serletti et al., 2000, and Sierakowski et al., 2017), whereas there have not been any such studies of plastic surgery procedures. We evaluated the risk factors for complications after plastic surgery procedures performed under general anesthesia in patients aged ≥75 years. Methods The cases of patients aged ≥75 years who underwent plastic surgery procedures under general anesthesia at the Department of Plastic and Reconstructive Surgery, National Hospital Organization Nagasaki Medical Center, between 2009 and 2016 were reviewed retrospectively. Multiple logistic regression analysis was used to identify the risk factors for postoperative complications. Results Two hundred and sixty-three cases were reviewed. Complications were seen in 137 patients. Age was not predictive of complications. The risk factors included a serum albumin level of <2.8 g/dl (odds ratio (OR): 2.96), an operative time of ≥120 min (OR: 6.22), and an American Society of Anesthesiologists performance status of ≥3 (OR: 2.39). Conclusions Age is not contraindication for surgery in the elderly. It is important to assess comorbidities and perform surgical procedures as soon as possible to shorten the surgical period.

Tratamiento del pie de Charcot complejo mediante cirugía en un solo tiempo con fijador circular estático. Serie de casos

ObjectiveWe present a case series report of patients with Charcot foot treated by single-stage surgery with static circular fixation. Material and methodRetrospective review of 10 cases treated with static circular external fixation since 2016, with the following inclusion criteria: 1) Deformity with any of the following: ulcers, osteoporosis, osteomyelitis or instability 2) peripheral neuropathy, 3) failed orthopaedic treatment. Exclusion criteria: 1) peripheral vascular obstruction without revascularization, 2) inability to comply with treatment, 3) non-ambulatory patients, 4) medical contraindication for surgery. Of the 10patients, 7men and 3women, 6had involvement of the left foot and 4of the right one. The average age of our patients was 58 years (range 39-71). We also evaluated Eichenholtz and Brodsky classification, presence of ulcers, osteomyelitis and instability. All were treated with circular external fixation with a medium follow up of 17 months (11-24 months). Postoperatively we evaluated limb salvation, ulcer healing, stability and re-ulcerations. ResultsIn all patients a functional plantigrade foot was achieved, cutaneous ulcer healed without recurrence. Four cases presented superficial pin infection, solved with local wound care. We had wire ruptures in 2 cases, which did not require replacement. We had a traumatic tibial fracture after frame removal, orthopedically solved. All patients were satisfied and would opt for the same technique, if necessary. Conclusionsof the study In Charcot foot, the objectives are to avoid amputation and achieve a functional plantigrade foot, without ulcer.Single-stage surgery with static circular external fixation is reproducible in our country, and also a valid technique for those cases in which internal fixation may not be the best option.

Effectiveness of medical treatment for Cushing\u2019s syndrome: a systematic review and meta-analysis

PurposeTo systematically review the effectiveness of medical treatment for Cushing’s syndrome in clinical practice, regarding cortisol secretion, clinical symptom improvement, and quality of life. To assess the occurrence of side effects of these medical therapies.MethodsEight electronic databases were searched in March 2017 to identify potentially relevant articles. Randomized controlled trials and cohort studies assessing the effectiveness of medical treatment in patients with Cushing’s syndrome, were eligible. Pooled proportions were reported including 95% confidence intervals.ResultsWe included 35 articles with in total 1520 patients in this meta-analysis. Most included patients had Cushing’s disease. Pooled reported percentage of patients with normalization of cortisol ranged from 35.7% for cabergoline to 81.8% for mitotane in Cushing’s disease. Patients using medication monotherapy showed a lower percentage of cortisol normalization compared to use of multiple medical agents (49.4 vs. 65.7%); this was even higher for patients with concurrent or previous radiotherapy (83.6%). Mild side effects were reported in 39.9%, and severe side effects were seen in 15.2% of patients after medical treatment. No meta-analyses were performed for clinical symptom improvement or quality of life due to lack of sufficient data.ConclusionsThis meta-analysis shows that medication induces cortisol normalization effectively in a large percentage of patients. Medical treatment for Cushing’s disease patients is thus a reasonable option in case of a contraindication for surgery, a recurrence, or in patients choosing not to have surgery. When experiencing side effects or no treatment effect, an alternate medical therapy or combination therapy can be considered.

Balloon-expandable stents for recoarctation of the aorta in small children. Two centre experience

BackgroundIn young patients with native aortic coarctation (CoA), the management of choice is surgery. However, in re-coarctation (re-CoA) surgery is associated with increased morbidity and even mortality. Some children with native CoA present relative contraindications for surgery. MethodsFrom 2006 to 2017, thirty-four patients (male n = 20; 59%) from two centres with re-CoA (31) and native CoA (3) were managed by stent implantation with premounted balloon expandable stents. Inclusion criteria were age < 3 years and >1 month, weight < 16 kg. Median age was 6,5 months (min. 1; max. 34 months), median weight 6,2 kg (min. 3,7; max. 16 kg). Thirteen patients (38%) had Re-CoA and hypoplastic left heart syndrome (HLHS). In three patients (9%) the native CoA was stented due to contraindications for surgical treatment. ResultsAll procedures were successful. The median peak invasive systolic pressure gradient declined from 31 mm Hg (max. 118; min. 4) to 0 mm Hg (max. 32; min.-7) (p < 0.001). The median minimal diameter of the narrowed segment of aorta increased from 3 mm (max. 6,9; min. 1,0) to 7 mm (max. 11,5; min. 3,5) (p < 0.001). There were no serious complications. The median follow-up time was 12,5 months (max. 88; min. 0 month). During this time ten patients (29%) required re-dilatation and two of them re-stenting. ConclusionPercutaneous stent implantation for Re-CoA and in selected patients for native CoA can be performed successfully in very young patients with a good immediate hemodynamical result. However, repeated stent angioplasties and further on interventional ‘opening’ of the stent is necessary to augment the aorta to adult size.

Proximal aortic surgery in the elderly population: Is advanced age a contraindication for surgery?

ObjectiveThe study objective was to describe the clinical outcomes of elderly patients undergoing ascending aortic surgery. MethodsPatients aged 70 years or older who underwent ascending aortic surgery between January 2002 and December 2013 were examined. Of 415 included patients, 285 were elderly patients (age 70-79 years) and 130 were very elderly (age ≥80 years). Logistic regression and Cox proportional hazards models were used to evaluate operative mortality and long-term survival, respectively. ResultsSurgical indications included aortic aneurysm (63.1%), calcified aorta with need for other cardiac procedure (26.4%), and type A dissection (10.5%). Compared with elderly patients, the very elderly patients had a higher burden of comorbidities and operative mortality (13% vs 7%, P < .04). The very elderly patients were also more likely to be discharged to a rehabilitation facility than home (P < .001). However, risk-adjusted operative mortality and 30-day readmissions rates were similar (P > .05). Kaplan–Meier estimates of survival at 1 and 5 years were 85.6% and 72.6% for elderly patients versus 79.2% and 57.1% for the very elderly patients. Age was a strong risk variable for late mortality in the unadjusted and adjusted analyses. ConclusionsAfter adjusting for these comorbidities, the cause of aortic disease, and the type of procedure, age was not an independent predictor of operative mortality, but was strongly associated with reduced late survival. Thus, advanced age alone should not be an absolute contraindication for ascending aortic surgery.

Mechanisms of dyspnoea in giant hiatus hernia: an indication to perform surgery?

Background The physiology of dyspnoea associated with giant hiatus hernia has not been well understood; however, it is generally considered a contraindication for surgery.

Observation - An Favorable Option Forthoracic Dissemination Patients with Lung Adenocarcinoma or Squamous Carcinoma

背景与目的手术非晚期期患者治疗的标准治疗，但是大量的回顾性研究显示胸腔内播散型肺癌接受主病灶切除后获益明显。非标准治疗之后患者该选择何种治疗策略？本研究通过回顾性数据去探究接受了主病灶切除的胸腔内播散型肺癌患者接下来何总治疗方式更优。方法回顾性收集早期肺腺癌或肺鳞癌且复发模式为胸腔内播散型患者；或拟行肺癌根治术，但术中胸腔探查发现胸腔内播散，接受主病灶切除的肺腺癌或肺鳞癌患者的一般资料、病理、淋巴结状态、基因突变状态、初始治疗方式等，随访至进展、死亡或失访，记录患者无进展生存时间、总生存时间、从确诊到开始治疗的时间。通过Kaplan-Meier绘制生存曲线，Log-rank检验比较组间生存差异，Cox比例回归风险模型分析无进展生存期（progression-free survival, PFS）和总生存期（overall survival, OS）相关预后因子。结果研究共纳入141例患者，70例r-M1a和71例s-M1a1患者。化疗组、靶向组、随访观察组患者中位PFS分别是14.7个月、41.0个月和31.0个月（95%CI: 19.01-26.01; P < 0.001），靶向治疗组和随访观察组患者PFS差异无统计学意义（P=0.600）。中位OS分别为39.0个月、42.6个月和38.1个月（95%CI: 32.47-45.33; P=0.478）。TTI < 3个月组和TTI≥3个月组患者的中位PFS分别是15.2个月和31.0个月（95%CI: 19.01-26.06; P<0.001），中位OS分别是41.7个月和38.7个月（95%CI: 32.47-45.33; P=0.714）。多因素分析显示性别（P=0.027）、淋巴结状态（P=0.036）、初始治疗方式（P<0.001）是PFS独立预后因子。结论随访观察不会缩短胸腔内播散腺癌和鳞癌患者的生存时间，是一种可选的治疗策略。

Sparing Treatment of Thoracic and Abdominal Aortic Aneurysms

A comparison of results of sparing treatment obtained at 2, 4 and 6 years of follow-up in subjects with descending aortic atherosclerotic aneurysms (DAAs), and during the period between 1.5 and 8.9 years in subjects with dissecting thoracoabdominal aortic aneurysms (DTAAs) has been made. All subjects received conservative treatment to maintain optimal levels of BP, cholesterol and LDL cholesterol, as well as to reduce oxidative and inflammatory processes in aorta, strengthen aortic walls and stabilize the course of the disease. Rapid negative changes (diameter increased by more than 5 mm within a 6-month period) and the absence of contraindications for surgery prompted us to perform open or endovascular aortic repair. Available data suggest that both DAAs and TAAs are comorbidities, which at any time can abruptly terminate patient’s life, and operative treatment guarantees no safety from ruptures. When using sparing treatment of DAA, survival rates were 90.1% at 2 years, 76.8% at 4 years, and 59.4% at 6 years, with uniform survival increment mainly due to comorbidity. Survival rate seen in TAA group (81.8%) was more acceptable due to a younger age of patients.

CyberKnife Stereotactic Radiosurgery for Primary and Metastatic Cancer in the Cervix.

Standard radiation therapy for cervical cancer consists of external beam radiation therapy followed by an intracavitary brachytherapy boost. When brachytherapy cannot be performed due to unfavorable anatomy or coexisting medical conditions, stereotactic body radiotherapy with the CyberKnife is another treatment option which is less invasive and can be performed in a shorter treatment time. We performed non-invasive therapy using the CyberKnife for five cases of urogenital cancer located in the cervix. The local tumor control was excellent with minimal toxicity. Non-invasive treatment was demonstrated as feasible with the CyberKnife for contraindication of surgery or brachytherapy.

Comparative Study of NOTES Versus Endoscopic Ultrasound Gastrojejunostomy in Pigs: A Prospective Study.

Surgical gastrojejunal anastomosis (GJJ) is considered the standard palliative option for gastric outlet obstruction. The use of endoscopic GJJ has generated a lot of attention and has enlarged the horizon for patients with open surgery contraindications. Our study aimed to assess and compare 2 purely endoscopic GJJ approaches using a lumen-apposing hot tip double-flanged metal stent, with focus on technical and clinical success rates on experimental animals. Two endoscopic GJJ techniques using a double-flanged self-expandable metal stent were compared on 8 pigs. Natural orifice transluminal endoscopic surgery (NOTES) was used on 4 pigs, while the other group was subjected to an endoscopic ultrasound (EUS) balloon-guided approach. On a 21-day follow-up, both EUS and NOTES-GJJ were technically successful in all experimental animals, and necropsy confirmed full integrity of the anastomosis. Adhesions were confirmed only on 2 pigs after NOTES procedure. The mean time for GJJ-NOTES completion was 31.375 ± 2.03, whereas EUS-GJJ was completed with a median time of 20.275 ± 0.65. The stent distance from the stomach varied; in NOTES-GJJ it was 47.8 ± 11.13 cm away from the pylorus, whereas in EUS-GJJ was at 37 ± 1.85 cm. No major complications were encountered during both procedures. EUS-GJJ balloon-guided approach might be a more attractive technique by using sonographic guidance, because of less endoscopic instrument changing as well as in achieving the desired anastomotic distance.

La demande de chirurgie esthétique : questions ouvertes et nouvelles perspectives pour la recherche

ObjectivesThis study aims to offer an overview of the most important results of current research on the request for cosmetic surgery, to provide some indications for practitioners working in the field, and to open new avenues for research. MethodWe analysed the theoretical contributions of seven psychoanalytical French authors that have closely studied this subject, linking their ideas to the international quantitative research on the subject. ResultsWe identified and discussed four major aspects in our literature review: the question of the patient's self-image and identity; the question of the role played by the other in the emergency on the desire for surgery; the dilemma of the existence or non-existence of therapeutic cosmetic surgery and the problem of the evaluation of the surgery's contraindications. Despite some important points of agreement between the authors, we have also identified some significant interpretative differences. ConclusionWe identified some interesting future research perspectives, and were able to provide some valuable responses to future professionals.

Conducting Psychosocial Evaluations of Bariatric Surgery Candidates

A comprehensive psychosocial evaluation is the standard of practice with potential bariatric surgery candidates. Pre-surgery psychosocial evaluations gather information via clinical interview and administration of objective psychological measures. Such evaluations have a dual purpose: first to screen for contraindications for surgery, and second to identify pre-surgery and post-surgery psychological treatment needs.

Decision of surgical approach for advanced gallbladder adenocarcinoma based on a Bayesian network.

To determine whether radical resection can benefit patients with advanced gallbladder adenocarcinoma using a Bayesian network (BN) with clinical data. In total, 362 patients who had undergone surgical treatment of gallbladder adenocarcinoma at a tertiary institute were evaluated to establish two BN models using a tree-augmented naïve Bayes algorithm. We then chose 250 patients with T3-4N0-2M0 stage gallbladder adenocarcinoma to test the posterior probability after the surgical type was taken into account. In total, 170 patients (≤7 months) and 137 patients (>7 months) were correctly classified in the median survival time model (accuracy, 84.81%), and 204 patients (≤12 months), 15 patients (12-36 months), 17 patients (36-60 months), and 34 patients (>60 months) were correctly classified in the 1-, 3-, and 5-year survival model (accuracy, 74.59%), respectively. Every posterior probability in the two models upregulated the ratio of the longer survival time and suggested a better prognosis for gallbladder adenocarcinoma that can be improved by R0 resection. These BN models indicate that stages T4 and N2 gallbladder adenocarcinoma are not contraindications for surgery and that R0 resection can improve survival in patients with advanced gallbladder adenocarcinoma.

Indications for surgical stabilization of rib fractures in patients without flail chest: surveyed opinions of members of the Chest Wall Injury Society.

There are currently no evidence-based indications for surgical stabilization of rib fractures (SSRF) in patients without flail chest. The purpose of this survey was to identify patients for whom there is relative equipoise (operative vs. non-operative) in order to assist in designing a randomized clinical trial. Members of the Chest Wall Injury Society were sent an online survey, in which 18 patient scenarios were presented. The baseline patient had ≥ three displaced, contiguous fractures and had no other contraindications for surgery. This default scenario was then varied based upon patient age, degree of traumatic brain injury (TBI), fracture series location, and number of abnormal pulmonary physiologic variables (oxygen requirement, respiratory rate, incentive spirometry ability, cough, and numeric pain score). Thirty respondents provided a total of 540 answers. Overall, the majority of responses were in favor of SSRF (n=413, 84.1%). Furthermore, the vast majority of responses indicated that some degree of pulmonary compromise was necessary to recommend SSRF (n=44, 90.4%), with ≥ two abnormal parameters being the most common threshold (n=156, 31.8%). Decision to recommend SSRF varied significantly by number of abnormal clinical variables, age, and degree of TBI, but not by fracture series location. Patients aged 85years old and those with moderate TBI were the least likely to be recommended for SSRF, regardless of abnormal pulmonary physiologic variables. The most appropriate cutoff for equipoise appeared to be a patient aged 21-79years old, with no or mild TBI, ≥ two abnormal pulmonary parameters, and regardless of fracture location (44.8% consensus for SSRF). SSRF was recommended for most patients with non-flail, displaced rib fractures. However, this recommendation was contingent upon patient age, degree of TBI, and pulmonary clinical status. Results of this survey may be used to inform inclusion criteria for a future randomized, clinical trial.

Prise en charge et gestion des patients demandeurs d’un lifting cervico-facial

Surgical and case management for patients demanding a face- and neck-lift are very important. The purpose of this paper is to help the plastic surgeons with information and recommendations useful for the best medical care of patients requiring a face- and neck-lift. The first consultation is the most important contact with the patient. The preoperative discussion helps to define patient demands and to evaluate eventual contraindications for surgery. The clinical exam and patient requirements are useful in the construction of the therapeutic proposition. This proposition is then confronted with patients' expectations and demands. The confrontation between the surgical proposition and patients' expectations allows to evaluate if it is appropriate, or not, to operate. At the end of the first consultation, the patient receives the information sheets of the French Plastic Surgery Society (SOFCPRE) according to the proposed surgical treatment. The second consultation makes it possible to verify the pertinence of the surgical act, to reiterate the preoperative recommendations, to confirm that the information given to the patient was well understood and to obtain the written consent from the patient. The written consent should include the fact that the patient received the information sheets of the SOFCPRE, that they were read and understood, and that the surgeon has transmitted the necessary information in order for the patient to take an informed and free decision to pursue with the surgery. The follow-up after surgery is as important as the surgery itself. In some cases, cosmetic gestures can be performed in the following months to obtain the best results possible and the highest satisfaction. The face- and neck-lift is an "adventure" for the patients and the postoperative difficulties should not be underestimated. However, the caring and professional support of the plastic surgeon and the support of someone of the patients' entourage can help the patient overcome this stage, and obtain a maximum benefit after this operation.

The impact of marital status on racial disparities in esophageal cancer care.

4056 Background: It is well known that racial disparities exist in cancer treatment and outcomes. The present study examined the impact of marital status as a surrogate for social support on esophageal cancer (EsC) care. Methods: We performed a secondary analysis of data collected from a state cancer registry. We included individuals with an EsC diagnosis between January 1, 2000 and December 31, 2013. A Chi-square test and Fisher’s exact test was used to analyze categorical variables and two-sample t-tests to compare continuous variables. Results: 8754 patients (Caucasian (C) or African American (AA) only) were included, with 88.4% C and 11.6% AA. Staging at diagnosis in C and AA patients revealed that 30.6% vs 28.6% had localized disease, followed by 33.8% vs 32.0% with regional, and 35.6% vs 40.0% with metastatic, respectively (p = .0155). Rates of chemotherapy (53.6% vs 53.5%) and radiation therapy (54.1% vs 56.2%) administration were found to be similar between C and AA patients. In contrast, surgery rates were significantly different between the two groups, with 29.7% of C undergoing surgical resection in comparison to only 12.0% of AA patients (p &lt; .0001). When evaluating marital status, 63.3% of C were married, compared to 33.4% of AA patients (p &lt; .0001). In the AA group, 20.1% of married patients underwent surgery in contrast to only 7.6% of single AAs (p &lt; .0001). Similarly, in the C group, married patients underwent surgery at a rate of 34.5%, while single patients went to surgery at a rate of 22.2% (p &lt; .0001). Surgery contraindication (CI) rates were found to be similar across all groups (5.6% married Cs, 5.2% married AAs, 6.6% single Cs, and 6.5% single AAs) along with surgery refusal rates (1.56% single Cs vs 2.68% married Cs (p = .052), and 1.04% single AAs vs 2.81% married AAs (p = .210)). Conclusions: African American patients receive chemotherapy and radiotherapy at comparable rates to Caucasian patients, but the rates of surgery are significantly lower. Being married was associated with an almost three-fold increase in surgery rates for AA patients, and cause a significant increase in Caucasians too.

Surgical management of aortopulmonary window: 24 years of experience and lessons learned.

Aortopulmonary window represents 0.2-0.3% of all congenital heart lesions. Progressive pulmonary arterial hypertension and its consequences are more common with this anomaly. The purpose of this study was to share 24 years of surgical experience in managing a spectrum of 55 cases of aortopulmonary window, followed up to 17 years in a single institution. This retrospective study was done from November 1991 to November 2015 of 55 patients with aortopulmonary window who underwent successful surgical repair. Age ranged from 5 months to 31 years with 45 children (12 years and younger) and 10 adults (older than 12 years). The male:female ratio was 2.2:1. The mean weight at operation was 14.63 kg (range 3.5-50 kg). An initial diagnosis was obtained from 2D echocardiography, which showed echo dropout in the parasternal short-axis view. Cardiac catheterization and angiography were performed in 54 out of 55 patients. Cardiac catheterization was not done in 1 patient who was 4 months of age. The mean right ventricular systolic pressure (RVSP) was 94 ± 2 mmHg, and the pulmonary artery mean pressure was 68 ± 2 mmHg. The average left to right shunt was 5.2:1, and the pulmonary vascular resistance index in room air was 7.97 ± 0.5 Wood units, whereas after oxygen administration, it declined to 2.0 ± 0.5 Wood units. Four surgical techniques were used based on the size of the communication and the anatomical conditions. There were no early or late deaths. There were no pulmonary hypertensive crises. All patients underwent echocardiography before discharge; none showed a residual shunt. Mild left ventricular dysfunction was seen in 2 patients. This dysfunction regressed with afterload reduction and diuretics on follow-up. All patients were followed up at intervals of 3 months, 1, 5 and 10 years, with the longest follow-up being 17 years. The mean follow-up period was 7 years. At follow-up, all patients were New York Heart Association class I. The mean RVSP on echocardiography was 32 mmHg at 3 months and 30 mmHg at 7 years with no change on further follow-up. Residual pulmonary hypertension was seen in 3 patients: 2 had mild pulmonary hypertension at 8-years follow-up and 1 had moderate hypertension at 3-months follow-up who required sildenafil postoperatively. Aortopulmonary window is a rare but well identified and surgically correctable anomaly. Operative repair should be offered as soon as the diagnosis is established, regardless of the patient's age. Irreversible pulmonary hypertension with a right to left shunt despite oxygen administration is the only contraindication for surgery. Various surgical techniques can be applied depending on the size of the communication. Associated arch anomalies may require technically challenging approaches and surgical strategies. Early and long-term outcomes after surgical correction are excellent regardless of age or pulmonary vascular resistance.

Results of an innovative bulking agent in patients with stress urinary incontinence who are not optimal candidates for mid-urethral sling surgery.

To assess the efficacy and safety of peri-urethral bulking injections (PBI) with an innovative bulking material (PDMS-U) in women with stress-urinary incontinence (SUI) who are not optimal candidates for mid-urethral sling surgery. A prospective study was performed in women with SUI who, for several reasons, have a relative contraindication for a mid-urethral sling procedure. These reasons include: (i) recurrent SUI after a prior SUI surgical procedure; (ii) a history of oncologic gynaecological surgery; (iii) a history of neurologic disease resulting in voiding problems; (iv) a maximal flow rate of less than 15 mL per second or; (v) women with a contraindication for surgery with general or regional anaesthesia. All women were treated with PBI consisting of PDMS-U, a bulking agent that polymerizes in situ. The primary outcome was subjective improvement, defined as "a little better" to "very much better" on the PGI-I. Secondary outcomes included objective cure, disease specific quality of life and adverse events. Subjective improvement was reported by 18 (90%) of the 20 included patients. The subjective cure rate was 56% and the objective cure rate was 65%. There was a statistically significant improvement of all domain scores of the UDI-6, IIQ-7, and PISQ-12 at 6 months follow up. Abnormal post voiding residual volume (>150 mL) was the most common adverse event (40%), but persisted in only one patient, based on the patient's preference for a catheter. PBI with PDMS-U is a viable treatment option in women with a relative contra-indication for mid-urethral sling surgery.

Comparison of long-term outcome between hemicolectomy and partial colectomy in the elderly: a large population-based study.

Due to large progress has been achieved in surgical techniques, anesthesia and perioperative care, it is accepted that the very elderly colon cancer (CC) patient is not contraindication for surgery. However, it is a controversy that an extended or a less aggressive surgical approach should be performed for this population. Here, we identified 28110 CC patients aged ≥80 from Surveillance, Epidemiology, and End-Results (SEER) database. The surgical approaches included extended hemicolectomy (HC) and partial colectomy (PC). 5-year cancer specific survival (CSS) was obtained. Kaplan–Meier methods and Cox regression models were used to assess the correlations between prognostic factors and long-term survival. The 5-year CSS for patients treated with HC were 45.6%, which were similar to patients who received PC (44.8%), the survival difference has no statistical significance (P=0.087). The result following propensity score matching further confirmed long-term survival were equal between HC and PC. However, patients in AJCC T3/T4 stage and with tumor size ≥5cm could obtain survival benefit from the extended surgery. In conclusion, most of elderly CC patients could not obtain survival benefit from extended resection. Partial colectomy should also be considered as an alternative approach for this group of patients.

Surgery for chronic subdural hematoma in nonagenarians: A Scandinavian population-based multicenter study.

Chronic subdural hematoma (cSDH) is a prevalent condition often seen in the elderly, with surgery being the treatment of choice when symptomatic. So far, few have explored the surgical outcomes in patients 90years or older. The aim of this study was to investigate outcome after cSDH surgery in nonagenarians (≥90 y/o group) compared to younger adult patients (<90 y/o group). In a Scandinavian population-based cohort we conducted a retrospective review of 1,254 patients undergoing primary burr-hole procedures for cSDH between January 1, 2005 and December 31, 2010 at three neurosurgical centers. In a comparative analysis, the primary end-point was difference in hematoma recurrence rates between the ≥90 y/o and <90 y/o groups. The secondary end-points were differences in perioperative morbidity and mortality between groups. 75 patients were 90years or older. There was no significant difference in recurrences resulting in reoperation between the age groups (10.7% vs 13.6%, P=.47). There was also no significant difference in overall complication rate (4.1% vs 8.1%, P=.21) or severe complications (1.4% vs 2.0%, P=.68). There were three (4.0%) perioperative deaths within 30days in the ≥90 y/o group and 40 (3.4%) in the <90 y/o group (P=.78). Patients 90years or older had similar rates of recurrence, perioperative morbidity and perioperative mortality as compared to younger patients. Age alone should not be a contraindication for surgery in patients with cSDH.