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Article

Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model

1
Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
2
Neurology, Public Health and Disability Unit, Fondazione IRCSS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
*
Author to whom correspondence should be addressed.
Both authors equally contributed to this article, and they should be considered the first authors.
Academic Editors: Nienke de Glas and Peter Hau
Cancers 2021, 13(10), 2320; https://doi.org/10.3390/cancers13102320
Received: 27 March 2021 / Revised: 28 April 2021 / Accepted: 10 May 2021 / Published: 12 May 2021
(This article belongs to the Special Issue Geriatric Oncology: From Research to Clinical Practice)
Brain tumor surgery in older patients is becoming more relevant, considering that the proportion of older adults being treated for cancer is rising, whereas some pivotal studies in neuro-oncology comprised young patients only. The knowledge of possible predictors of outcome should be included in the preoperative assessment to make the best possible decision in terms of management. We present a case series of 143 patients older than 65 years, intending to identify the possible factors predicting the risk of clinical worsening after elective surgical resection of intracranial tumors in elderly patients. We found that postoperative complications occurrence and preoperative surgical complexity significantly influence the outcome in this subgroup of patients, whereas postoperative complications were the only factor with an impact also at long-term follow-up.
The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological surgery in elderly patients. Therefore, all patients ≥65 years old who underwent BT resection at a tertiary referral center between 01/2018 and 12/2019 were included. Age, smoking, previous radiotherapy, hypertension, preoperative functional status, complications occurrence, surgical complexity and the presence of comorbidities were prospectively collected and analyzed at discharge and the 3-month follow-up. The series included 143 patients (mean 71 years, range 65–86). Sixty-five patients (46%) had at least one neurosurgical complication, whereas 48/65 (74%) complications did not require invasive treatment. Forty-two patients (29.4%) worsened at discharge; these patients had a greater number of complications compared to patients with unchanged/improved performance status. A persistent worsening at three months of follow-up was noted in 20.3% of patients; again, this subgroup presented more complications than patients who remained equal or improved. Therefore, postoperative complications and surgical complexity seem to influence significantly the early outcome in elderly patients undergoing brain tumor surgery. In contrast, postoperative complications alone are the only factor with an impact on the 3-month follow-up. View Full-Text
Keywords: brain tumors; complications; craniotomy; elderly; KPS; mortality; predicting factors; outcome brain tumors; complications; craniotomy; elderly; KPS; mortality; predicting factors; outcome
MDPI and ACS Style

Ferroli, P.; Vetrano, I.G.; Schiavolin, S.; Acerbi, F.; Zattra, C.M.; Schiariti, M.; Leonardi, M.; Broggi, M. Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model. Cancers 2021, 13, 2320. https://doi.org/10.3390/cancers13102320

AMA Style

Ferroli P, Vetrano IG, Schiavolin S, Acerbi F, Zattra CM, Schiariti M, Leonardi M, Broggi M. Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model. Cancers. 2021; 13(10):2320. https://doi.org/10.3390/cancers13102320

Chicago/Turabian Style

Ferroli, Paolo, Ignazio G. Vetrano, Silvia Schiavolin, Francesco Acerbi, Costanza M. Zattra, Marco Schiariti, Matilde Leonardi, and Morgan Broggi. 2021. "Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model" Cancers 13, no. 10: 2320. https://doi.org/10.3390/cancers13102320

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