Oncogeriatrics (part 4.) Pre-operative assessment of elderly patients with cancer

Older patients comprise a highly heterogeneous group, and chronological age, comorbidities, or the type of surgical pro­cedure performed cannot adequately describe the risk of adverse post-operative outcomes. Therefore, current routine pre­-operative assessment also cannot adequately identify patients at risk. The Comprehensive Geriatric Assessment, the mean life expectancy and the treatment goals of a patient must be included in the pre-operative evaluation. The Comprehensive Geriatric Assessment helps to determine the primary status of an older patient, to diagnose frailty syndrome and to identify how to optimize a patient’s condition before surgery. Surgery is one of the primary triggers for disability in older patients. In this age group, being independent is more important than prolonging life. This is particularly true in patients with frailty syndrome, or decreased physiological reserves, which arise from cumulative deficits in several physiological systems and result in a diminished resistance to stressors. Therefore, a standardized pre-operative diagnostic approach, individualized surgical technique selection and tailored post-operative care are essential for successful treatment of elderly patients.Older patients comprise a highly heterogeneous group, and chronological age, comorbidities, or the type of surgical procedure performed cannot adequately describe the risk of adverse post-operative outcomes. Therefore, current routine pre-operative assessment also cannot adequately identify patients at risk. The Comprehensive Geriatric Assessment, the mean life expectancy and the treatment goals of a patient must be included in the pre-operative evaluation. The Comprehensive Geriatric Assessment helps to determine the primary status of an older patient, to diagnose frailty syndrome and to identify how to optimize a patient’s condition before surgery. Surgery is one of the primary triggers for disability in older patients. In this age group, being independent is more important than prolonging life. This is particularly true in patients with frailty syndrome, or decreased physiological reserves, which arise from cumulative deficits in several physiological systems and result in a diminished resistance to stressors. Therefore, a standardized pre-operative diagnostic approach, individualized surgical technique selection and tailored post-operative care are essential for successful treatment of elderly patients