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Zentralbl Chir 2015; 140(03): 304-311
DOI: 10.1055/s-0032-1328214
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Gibt es ein Alterslimit für chirurgische Maßnahmen?

Is There an Age Limit for Surgical Interventions?
R. Mennigen
Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster, Münster, Deutschland
,
N. Senninger
Klinik und Poliklinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster, Münster, Deutschland
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Publication History

Publication Date:
21 May 2013 (online)

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Zusammenfassung

Die demografische Entwicklung bedingt zwangsläufig eine Zunahme älterer Patienten (> 70 Jahre), die chirurgische Maßnahmen benötigen. Mittlerweile werden auch große chirurgische Eingriffe bei hochbetagten Patienten mit guten Ergebnissen durchgeführt. Auch radikale onkologische Operationen machen im hohen Lebensalter angesichts einer immer höheren Lebenserwartung Sinn. Während das kalendarische Lebensalter selbst kein Risikofaktor für perioperative Komplikationen ist und daher kein Alterslimit für chirurgische Maßnahmen existiert, können die im Alter in hoher Frequenz vorhandenen Komorbiditäten und die eingeschränkten funktionellen Reserven das Operationsrisiko massiv erhöhen. Insofern muss für den einzelnen Patienten eine individuelle Abwägung der Vor- und Nachteile einer chirurgischen Maßnahme erfolgen. Ein spezialisiertes geriatrisches Assessment und ein optimales perioperatives Management des alten Patienten können die Ergebnisse einer chirurgischen Therapie verbessern.

Abstract

The demographic development leads to an increase of elderly patients (> 70 years) who require surgical interventions. Nowadays, even complex surgical interventions are performed with good results in very old patients. In view of an increasing life expectancy, radical oncological surgery makes sense even in high age. High age itself is not a risk factor for perioperative morbidity and mortality, and therefore there is no age limit for surgical interventions. However, comorbidities are more frequent in old patients, and these can massively increase the risk of surgery. Thus, for the individual patient, pros and cons of surgical interventions have to be weighed up. A specialised geriatric assessment and an optimal perioperative management of the old patient can improve the results of surgical therapy.

Schlüsselwörter

Chirurgie im Alter - Demografie - Alter - Geriatrie

Key words

surgery for the elderly - demography - age - geriatric medicine
 

  • Literatur

  • 1 Statistisches Bundesamt. Bevölkerung Deutschlands bis 2060 – 12. koordinierte Bevölkerungsvorausberechnung. https://www.destatis.de/DE/Publikationen/Thematisch/Bevoelkerung/VorausberechnungBevoelkerung/BevoelkerungDeutschland2060Presse.html Stand: 27.10.2012
    PubMedGoogle Scholar
  • 2 Osterkamp R. Bevölkerungsentwicklung in Deutschland bis 2050. Chirurg 2005; 76: 10-18
    CrossrefPubMedGoogle Scholar
  • 3 Wiedemann D, Bernhard D, Laufer G et al. The elderly patient and cardiac surgery – a mini-review. Gerontology 2010; 56: 241-249
    CrossrefPubMedGoogle Scholar
  • 4 Adam R, Frilling A, Elias D et al. Liver resection of colorectal metastases in elderly patients. Br J Surg 2010; 97: 366-376
    CrossrefPubMedGoogle Scholar
  • 5 Fogh SE, Yu A, Kubicek GJ et al. Do elderly patients experience increased perioperative or postoperative morbidity or mortality when given neoadjuvant chemoradiation before esophagectomy?. Int J Radiat Oncol Biol Phys 2011; 80: 1372-1376
    CrossrefPubMedGoogle Scholar
  • 6 Mirici-Cappa F, Gramenzi A, Santi V et al. Treatments for hepatocellular carcinoma in elderly patients are as effective as in younger patients: a 20-year multicentre experience. Gut 2010; 59: 387-396
    CrossrefPubMedGoogle Scholar
  • 7 Pultrum BB, Bosch DJ, Nijsten MW et al. Extended esophagectomy in elderly patients with esophageal cancer: minor effect of age alone in determining the postoperative course and survival. Ann Surg Oncol 2010; 17: 1572-1580
    CrossrefPubMedGoogle Scholar
  • 8 Duron JJ, Duron E, Dugue T et al. Risk factors for mortality in major digestive surgery in the elderly: a multicenter prospective study. Ann Surg 2011; 254: 375-382
    CrossrefPubMedGoogle Scholar
  • 9 Internullo E, Moons J, Nafteux P et al. Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Eur J Cardiothorac Surg 2008; 33: 1096-1104
    CrossrefPubMedGoogle Scholar
  • 10 Pallis AG, Fortpied C, Wedding U et al. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 2010; 46: 1502-1513
    CrossrefPubMedGoogle Scholar
  • 11 Statistisches Bundesamt. Sterbetafel Deutschland 2008/2010. https://www.destatis.de/DE/Publikationen/Thematisch/Bevoelkerung/Bevoelkerungsbewegung/Periodensterbetafeln.html Stand: 27.10.2012
    PubMedGoogle Scholar
  • 12 Preston SD, Southall AR, Nel M et al. Geriatric surgery is about disease, not age. J R Soc Med 2008; 101: 409-415
    CrossrefPubMedGoogle Scholar
  • 13 Hestermann U, Thomas C, Oster P. „FRAGILE“ – Der alte Mensch und die Chirurgie. Chirurg 2005; 76: 28-34
    CrossrefPubMedGoogle Scholar
  • 14 Bockler D, Schumacher H, Allenberg JR. Gefäßchirurgie im Alter. Chirurg 2005; 76: 113-125
    CrossrefPubMedGoogle Scholar
  • 15 Levine WC, Mehta V, Landesberg G. Anesthesia for the elderly: selected topics. Curr Opin Anaesthesiol 2006; 19: 320-324
    CrossrefPubMedGoogle Scholar
  • 16 Audisio RA, Veronesi P, Ferrario L et al. Elective surgery for gastrointestinal tumours in the elderly. Ann Oncol 1997; 8: 317-326
    CrossrefPubMedGoogle Scholar
  • 17 Colloca G, Santoro M, Gambassi G. Age-related physiologic changes and perioperative management of elderly patients. Surg Oncol 2010; 19: 124-130
    CrossrefPubMedGoogle Scholar
  • 18 Moller JT, Cluitmans P, Rasmussen LS et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 1998; 351: 857-861
    CrossrefPubMedGoogle Scholar
  • 19 Endreseth BH, Romundstad P, Myrvold HE et al. Rectal cancer treatment of the elderly. Colorectal Dis 2006; 8: 471-479
    CrossrefPubMedGoogle Scholar
  • 20 Mamidanna R, Eid-Arimoku L, Almoudaris AM et al. Poor 1-year survival in elderly patients undergoing nonelective colorectal resection. Dis Colon Rectum 2012; 55: 788-796
    CrossrefPubMedGoogle Scholar
  • 21 Reddy SK, Barbas AS, Turley RS et al. Major liver resection in elderly patients: a multi-institutional analysis. J Am Coll Surg 2011; 212: 787-795
    CrossrefPubMedGoogle Scholar
  • 22 Petrowsky H, Clavien PA. Should we deny surgery for malignant hepato-pancreatico-biliary tumors to elderly patients?. World J Surg 2005; 29: 1093-1100
    CrossrefPubMedGoogle Scholar
  • 23 Chambers A, Routledge T, Pilling J et al. In elderly patients with lung cancer is resection justified in terms of morbidity, mortality and residual quality of life?. Interact Cardiovasc Thorac Surg 2010; 10: 1015-1021
    CrossrefPubMedGoogle Scholar
  • 24 Tani M, Kawai M, Hirono S et al. A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age. J Hepatobiliary Pancreat Surg 2009; 16: 675-680
    CrossrefPubMedGoogle Scholar
  • 25 Pofahl WE, Pories WJ. Current status and future directions of geriatric general surgery. J Am Geriatr Soc 2003; 51: S351-S354
    CrossrefPubMedGoogle Scholar
  • 26 Ingraham AM, Cohen ME, Raval MV et al. Variation in quality of care after emergency general surgery procedures in the elderly. J Am Coll Surg 2011; 212: 1039-1048
    CrossrefPubMedGoogle Scholar
  • 27 Mulcahy HE, Patchett SE, Daly L et al. Prognosis of elderly patients with large bowel cancer. Br J Surg 1994; 81: 736-738
    CrossrefPubMedGoogle Scholar
  • 28 Colorectal Cancer Collaborative Group. Surgery for colorectal cancer in elderly patients: a systematic review. Lancet 2000; 356: 968-974
    CrossrefPubMedGoogle Scholar
  • 29 Kapan M, Onder A, Tekbas G et al. Percutaneous cholecystostomy in high-risk elderly patients with acute cholecystitis: a lifesaving option. Am J Hosp Palliat Care 2013; 30: 167-171
    CrossrefPubMedGoogle Scholar
  • 30 Oida T, Kano H, Mimatsu K et al. Percutaneous drainage in conservative therapy for perforated gastroduodenal ulcers. Hepatogastroenterology 2012; 59: 168-170
    PubMedGoogle Scholar
  • 31 Repici A, De Caro G, Luigiano C et al. WallFlex colonic stent placement for management of malignant colonic obstruction: a prospective study at two centers. Gastrointest Endosc 2008; 67: 77-84
    CrossrefPubMedGoogle Scholar
  • 32 Senninger N, Anthoni C. Onkologische Viszeralchirurgie im Alter. Chirurg 2005; 76: 43-46
    CrossrefPubMedGoogle Scholar
  • 33 Hoekstra HJ. Cancer surgery in the elderly. Eur J Cancer 2001; 37 (Suppl. 07) S235-S244
    PubMedGoogle Scholar
  • 34 Gelsomino S, Lorusso R, Livi U et al. Cost and cost-effectiveness of cardiac surgery in elderly patients. J Thorac Cardiovasc Surg 2011; 142: 1062-1073
    CrossrefPubMedGoogle Scholar
  • 35 Wu Y, Jin R, Gao G et al. Cost-effectiveness of aortic valve replacement in the elderly: an introductory study. J Thorac Cardiovasc Surg 2007; 133: 608-613
    CrossrefPubMedGoogle Scholar
  • 36 Cunningham D, Allum WH, Stenning SP et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20
    CrossrefPubMedGoogle Scholar
  • 37 Ghanta RK, Shekar PS, McGurk S et al. Long-term survival and quality of life justify cardiac surgery in the very elderly patient. Ann Thorac Surg 2011; 92: 851-857
    CrossrefPubMedGoogle Scholar
  • 38 Srinivasan AK, Oo AY, Grayson AD et al. Mid-term survival after cardiac surgery in elderly patients: analysis of predictors for increased mortality. Interact Cardiovasc Thorac Surg 2004; 3: 289-293
    CrossrefPubMedGoogle Scholar
  • 39 Fairhead JF, Rothwell PM. Underinvestigation and undertreatment of carotid disease in elderly patients with transient ischaemic attack and stroke: comparative population based study. BMJ 2006; 333: 525-527
    CrossrefPubMedGoogle Scholar
  • 40 Demirel S, Hyhlik-Durr A, Attigah N et al. Gefäßchirurgie im Alter – Handlungsempfehlungen für die chirurgische Praxis. Zentralbl Chir 2011; 136: 471-479
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Bond R, Rerkasem K, Cuffe R et al. A systematic review of the associations between age and sex and the operative risks of carotid endarterectomy. Cerebrovasc Dis 2005; 20: 69-77
    CrossrefPubMedGoogle Scholar
  • 42 Geraghty PJ, Sicard GA. Abdominal aortic aneurysm repair in high-risk and elderly patients. J Cardiovasc Surg (Torino) 2003; 44: 543-547
    PubMedGoogle Scholar
  • 43 Lange C, Leurs LJ, Buth J et al. Endovascular repair of abdominal aortic aneurysm in octogenarians: an analysis based on EUROSTAR data. J Vasc Surg 2005; 42: 624-630
    PubMedGoogle Scholar
  • 44 Wurtz LD, Feinberg JR, Capello WN et al. Elective primary total hip arthroplasty in octogenarians. J Gerontol A Biol Sci Med Sci 2003; 58: M468-M471
    CrossrefPubMedGoogle Scholar
  • 45 Gassel HJ, Meyer D, Sailer M et al. Nichtonkologische Viszeralchirurgie im Alter. Chirurg 2005; 76: 35-42
    CrossrefPubMedGoogle Scholar
  • 46 Stollman N, Raskin JB. Diverticular disease of the colon. Lancet 2004; 363: 631-639
    CrossrefPubMedGoogle Scholar
  • 47 Grailey K, Markar SR, Karthikesalingam A et al. Laparoscopic versus open colorectal resection in the elderly population. Surg Endosc 2013; 27: 19-30
    CrossrefPubMedGoogle Scholar
  • 48 Martinek L, Dostalik J, Gunka I et al. Ist das Alter ein Risikofaktor für laparoskopische kolorektale Operationen?. Zentralbl Chir 2011; 136: 264-268
    Article in Thieme ConnectPubMedGoogle Scholar
  • 49 Fitzgibbons jr. RJ, Giobbie-Hurder A, Gibbs JO et al. Watchful waiting vs. repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006; 295: 285-292
    CrossrefPubMedGoogle Scholar
  • 50 Sarosi GA, Wei Y, Gibbs JO et al. A clinicianʼs guide to patient selection for watchful waiting management of inguinal hernia. Ann Surg 2011; 253: 605-610
    CrossrefPubMedGoogle Scholar
  • 51 Chung L, Norrie J, OʼDwyer PJ. Long-term follow-up of patients with a painless inguinal hernia from a randomized clinical trial. Br J Surg 2011; 98: 596-599
    CrossrefPubMedGoogle Scholar
  • 52 Tran Ba Loc P, du Montcel ST, Duron JJ et al. Elderly POSSUM, a dedicated score for prediction of mortality and morbidity after major colorectal surgery in older patients. Br J Surg 2010; 97: 396-403
    CrossrefPubMedGoogle Scholar
  • 53 Watanabe M, Iwatsuki M, Iwagami S et al. Prognostic nutritional index predicts outcomes of gastrectomy in the elderly. World J Surg 2012; 36: 1632-1639
    CrossrefPubMedGoogle Scholar
  • 54 Cronin J, Livhits M, Mercado C et al. Quality improvement pilot program for vulnerable elderly surgical patients. Am Surg 2011; 77: 1305-1308
    PubMedGoogle Scholar
  • 55 Gao T, Li N, Zhang JJ et al. Restricted intravenous fluid regimen reduces the rate of postoperative complications and alters immunological activity of elderly patients operated for abdominal cancer: a randomized prospective clinical trail. World J Surg 2012; 36: 993-1002
    CrossrefPubMedGoogle Scholar