Comparison of survival of surgical resection and conservative treatment in patients with gastric cancer aged 80 years or older: a single-center experience

PURPOSE: With the increase in the average life expectancy, the elderly population continues to increase rapidly. However, no consensus has been reached on the feasibility for surgical resection due to the high morbidity and mortality rate after surgical treatment in elderly patients caused by aging and underlying diseases. METHODS: This study was performed with patients aged 80 years and older. The subjects were classified into 2 groups as follows: the surgical resection group consisting of 61 patients, and the conservative treatment group consisting of 39 patients suitable for curative resection. RESULTS: Mean age and clinical stages in the conservative treatment group were higher than those in the surgical resection group. There was no significant difference in sex, location of the lesion, histological type, or underlying disease. The mean survival time of surgical resection group and conservative treatment group was respectively 52.1 ± 2.66 months and 37.1 ± 5.08 months (P < 0.05) for clinical stage 1 disease, 41.7 ± 5.16 months and 22.4 ± 6.07 months (P = 0.004) for stage 2 disease, and 31.7 ± 9.37 months and 10.6 ± 1.80 months (P = 0.049) for stage 3 disease. However, as for the extent of lymph node resection for the different stages, we observed no significant difference between the 2 groups. CONCLUSION: Surgical resection in all clinical stages, except stage 4, showed a higher survival rate than conservative treatment. To minimize postoperative surgery complications, limited lymph node dissection should also be considered.

Clinical outcome for laparoscopic cholecystectomy in extremely elderly patients

PURPOSE: Extremely elderly patients who present with complicated gallstone disease are less likely to undergo definitive treatment. The use of laparoscopic cholecystectomy (LC) in older patients is complicated by comorbid conditions that are concomitant with advanced age and may increase postoperative complications and the frequency of conversion to open surgery. We aimed to evaluate the results of LC in patients (older than 80 years). METHODS: We retrospectively analyzed 302 patients who underwent LC for acute cholecystitis between January 2011 and December 2013. Total patients were divided into three groups: group 1 patients were younger than 65 years, group 2 patients were between 65 and 79 years, and group 3 patients were older than 80 years. Patient characteristics were compared between the different groups. RESULTS: The conversion rate was significantly higher in group 3 compared to that in the other groups. Hematoma in gallbladder fossa and intraoperative bleeding were higher in group 3, the difference was not significant. Wound infection was not different between the three groups. Operating time and postoperative hospital stay were significantly higher in group 3 compared to those in the other groups. There was no reported bile leakage and operative mortality. Preoperative percutaneous transhepatic gallbladder drainage and endoscopic retrograde cholangiopancreatography were performed more frequently in group 3 than in the other groups. CONCLUSION: LC is safe and feasible. It should be the gold-standard approach for extremely elderly patients with acute cholecystitis.

Correlation analysis between type 2 diabetes mellitus and thyroid nodules in elderly patients / 第二军医大学学报

To investigate the prevalence of thyroid nodules in elderly patients (age≥80 years) with type 2 diabetes mellitus (T2DM), and to analyze the correlation between thyroid nodules and type 2 diabetes mellitus. Methods The study included two groups: one group included 103 patients with T2DM (diabetic group) and the other group included 103 patients without T2DM (control group). Information including clinical history, fasting plasma glucose(FPG), thyroid hormone, and ultrasonic finding of thyroid glands was collected for both groups. The clinical features of thyroid nodules were compared between the two groups and their relationship with other indices was analyzed. Results (1)The prevalence rate of thyroid nodules in diabetic group was greatly higher than that of the control group (84.47% vs 70.59%). The proportion of patients with multiple nodules was as high as 80.46% in the diabetic group. Presence of thyroid nodule was significantly associated with patient ages (χ2=7.060, P<0.05), but not with gender, body mass index (BMI), or serum glucose level. (2) The positive rate of thyroid dysfunction in the diabetic group was significantly higher than that in the control group (15.53% vs 6.80%, P<0.05). The prevalence rates of sub-clinical hypothyroidism were similar between the two groups. T3 and T4 levels of thyroid function in the diabetic group were significantly lower than those in the control group (P<0.05), and the thyroid stimulating hormone (TSH) levels were similar between the two groups. Conclusion Elderly patients (age≥80 years) have a higher liability for thyroid disease, which may affect the control and prognosis of diabetes. It is recommended for those patients to receive regular check-up for thyroid function and morphology changes.