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Preoperative Assessment of Surgical Risk in Oncogeriatric Patients

^a University of Liverpool, Liverpool, UK; ^b Whiston Hospital, Prescot, Merseyside, UK; ^c Yale University School of Medicine, New Haven, Connecticut, USA; ^d University of West Indies, St. Michael, Barbados

Correspondence: Riccardo A. Audisio, M.D., F.R.C.S., Consultant Surgical Oncologist, Hon Senior Lecturer, University of Liverpool, Whiston Hospital, Prescot, L35 5DR, UK. Telephone: 44-151-430-1079; Fax: 44-151-430-1891; e-mail: raudisio{at}doctors.org.uk

Cancer is a prevalent disease in our aging population; however, few oncologists are familiar with caring for oncogeriatric patients. Surgery is presently the treatment of choice for most solid tumors, but it is frequently delivered in a suboptimal way in this patient subsetting. Undertreatment is often justified with the concern of an unsustainable toxicity, while overtreatment can be related to the lack of knowledge in optimizing preoperative risk assessment. To draw new light on this issue, several surgeons presented their series, providing hard evidence that surgical options can be offered to the elderly with cancer, with only a limited postoperative mortality and morbidity. As it is likely that much of these data suffer from selection bias, we concentrated on Comprehensive Geriatric Assessment (CGA), which can add substantial information on the functional assessment of elderly cancer patients. A validated instrument such as the CGA allows a comparison of series, predicting short-term surgical outcomes more precisely, and offers appropriate information when consenting elderly patients. Preoperative Assessment of Cancer in the Elderly is a prospective international study conceived and launched to outline the fitness of elderly surgical patients with malignant tumors. This paper reports on preliminary results and analysis from the ongoing study.

Key Words. Cancer • Elderly • Surgical risk • Risk assessment • Comorbidities • Aged

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