Ghignone F, van Leeuwen B L, Montroni I, Huisman M G, Somasundar P, Cheung K L, Audisio R A, Ugolini G
University of Bologna, Policlinico S. Orsola-Malpighi, Department of Surgery, Via Giuseppe Massarenti 9, 40138 Bologna, Italy.
University of Groningen, University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Eur J Surg Oncol. 2016 Feb;42(2):297-302. doi: 10.1016/j.ejso.2015.12.004. Epub 2015 Dec 17.
The Surgical Task Force at SIOG (International Society of Geriatric Oncology) designed this survey to explore the surgical oncologists' approach toward elderly cancer patients.
A web-based survey was sent to all members of ESSO (European Society of Surgical Oncology) and SSO (Society of Surgical Oncology).
Two hundred and fifty-one surgeons responded (11% response rate) with a main interest on breast (62.1%), colorectal (43%) and hepatobiliary (27.4%) surgery. Almost all surgeons (>90%) offer surgery regardless the patient's age; only 48% consider mandatory a preoperative frailty assessment. The American Society of Anesthesiologists (ASA) score, nutritional and performance status are most frequently used as screening tools; only 6.4% surgeons use Comprehensive Geriatric Assessment (CGA) in daily practice and collaboration with geriatricians is low (36.3%). If proven to be effective, the majority of surgeons (71%) is prepared to pre-habilitate patients for up to 4 weeks before surgery. One in two surgeons would not offer an operation to patients with impaired cognitive status; conversely, one in three would proceed to surgery regardless of the patient's cognitive status, if functional capacity is conserved. Quality of life and functional recovery are regarded as the most important endpoints in onco-geriatric surgery. Large "real life" prospective observational studies and randomized controlled trials are demanded.
Age is not perceived as a limitation to surgery. Screening for frailty is limited. A thorough CGA is seldom used and collaboration with geriatricians is rather uncommon. There is a need for clinical investigations focusing on pre-habilitation and other strategies to achieve better functional recovery.
国际老年肿瘤学会（SIOG）手术特别工作组设计了这项调查，以探究外科肿瘤学家对老年癌症患者的治疗方法。
向欧洲外科肿瘤学会（ESSO）和外科肿瘤学会（SSO）的所有成员发送了一项基于网络的调查。
251名外科医生做出了回应（回应率为11%），他们主要关注乳腺癌（62.1%）、结直肠癌（43%）和肝胆外科手术（27.4%）。几乎所有外科医生（>90%）无论患者年龄大小都提供手术；只有48%的医生认为术前进行衰弱评估是必要的。美国麻醉医师协会（ASA）评分、营养状况和体能状态是最常用的筛查工具；只有6.4%的外科医生在日常实践中使用综合老年评估（CGA），并且与老年病医生的合作较少（36.3%）。如果被证明有效，大多数外科医生（71%）准备在手术前对患者进行长达4周的术前康复训练。每两名外科医生中有一名不会为认知状态受损的患者进行手术；相反，如果功能能力得以保留，每三名外科医生中有一名会不顾患者的认知状态而进行手术。生活质量和功能恢复被视为老年肿瘤外科中最重要的终点。需要进行大型“真实生活”前瞻性观察研究和随机对照试验。
年龄不被视为手术的限制因素。对衰弱的筛查有限。很少使用全面的CGA，与老年病医生的合作也相当少见。需要开展侧重于术前康复训练和其他实现更好功能恢复策略的临床研究。
