K. H. Wilkinson1, C. G. Ethun2, M. Hembrook1, M. Bedi5, J. Charlson4, H. Mogal1, K. K. Christians1, T. B. Tran3, G. Poultsides3, V. Grignol6, J. H. Howard6, J. Tseng7, K. K. Roggin7, K. Chouliaras8, K. Votanopoulos8, D. Cullinan9, R. C. Fields9, S. Weber10, T. C. Gamblin1, K. Cardona2, C. N. Clarke1 1Medical College Of Wisconsin,Division Of Surgical Oncology,Milwaukee, WI, USA 2Winship Cancer Institute, Emory University,Department Of Surgery,Atlanta, GA, USA 3Stanford University,Department Of Surgery,Palo Alto, CA, USA 4Medical College Of Wisconsin,Department Of Medical Oncology,Milawuakee, WI, USA 5Medical College Of Wisconsin,Department Of Radiation Oncology,Milwaukee, WI, USA 6The Ohio State University,Department Of Surgery,Columbus, OH, USA 7University Of Chicago,Department Of Surgery,Chicago, IL, USA 8Wake Forest University,Department Of Surgery,Winston-Salem, NC, USA 9Washington University,Department Of Surgery,St. Louis, MO, USA 10University Of Wisconsin,Department Of Surgery,Madision, WI, USA
Introduction: Little is known about the postoperative outcomes of elderly (≥70yrs) patients undergoing radical resection of retroperitoneal sarcomas (RPS). We hypothesize that biological age impacts outcomes and prognosis after surgical resection in patients with RPS.
Methods: Three hundred and nine patients undergoing surgical resection for primary or recurrent RPS between 2000 and 2015 at participating US Sarcoma Collaborative institutions were identified. Patient demographics, perioperative morbidity, mortality, length of stay (LOS), discharge to home, disease specific survival (DSS) and disease free-survival (DFS) were compared between elderly (≥70yrs, n=69) and non-elderly (<70yrs, n= 240) patients.
Results: Median age at time of surgery for elderly and non-elderly patients was 76yrs (IQR=7) and 55yrs (IQR=18), respectively . Elderly patients had a median ASA of 3 (IQR =1) while non-elderly had a median of 2 (IQR =1). Median tumor size was larger in the elderly group (12 cm [IQR=15] vs. 9 cm [IQR=8], p =0.004). There was no difference in median operative time (183 mins [IQR 114] vs. 214 mins [IQR 191], p= 0.06) or estimated blood loss (300 mL [IQR 650] vs. 300mL [IQR 900], p= 0.22) between elderly and non-elderly patients. Thirty-two (39%) elderly patients underwent bowel resection, 7 (8.5%) nephrectomy, 4 (4.9%) pancreatic resection, 2 (2.9%) liver resection, and 3 (4.3%) major vascular resection. Incidence of total and major complications was comparable between groups (elderly vs. non-elderly: 42.0% vs. 38.8%; p = 0.62 and 24.6% vs. 20.0%; p = 0.41). LOS was similar with a median of 8 days (IQR 6) in the elderly group and 6 days (IQR 5) in the non-elderly group, p= 0.64. There was no difference in 30-day readmission rates between elderly and non-elderly patients (11.6% and 10.8%, p= 0.86). 61 (88.4%) elderly patients were discharged to home, 2 (2.9%) to subacute rehab facilities and 5 (7.2%) to skilled nursing facilities. Perioperative mortality was comparable in both groups (elderly vs. non-elderly, 0% vs 0.2% p= 0.28). There was no difference in three-year DFS between the elderly and non-elderly patients (18.8% vs 21.6% p=0.61) however elderly patients had lower three-year DSS (25.1% vs 56.1% p< 0.001) (Figure).
Conclusion: Elderly patients undergoing resection for retroperitoneal sarcoma at high-volume academic centers demonstrated analogous perioperative morbidity and mortality when compared to their younger counterparts. Three-year DFS was similar between groups however, elderly patients are more likely to die from their disease after recurrence as evidenced by lower DSS compared with younger patients.
