Gastric Surgery in Elderly Patients
ELDERLY patients are correctly regarded as substandard risks for abdominal operations. Possibly because of this fact and the additional precautions that surgeons habitually exercise for the elderly, it is noteworthy that indicated operations for gastric or duodenal lesions can be performed just about as safely in the elderly patients as in the young ones. There are two exceptions to the over-all safety existing for elderly patients: generally, there is a sharp increase in the incidence of nonfatal complications involving the cardiovascular system, urinary tract, and lungs after age 60 years; and similarly, there is a greater likelihood of postoperative mortality in the hospital, or within one month, for elderly patients suffering from malignant gastric lesions that are surgically incurable, than for younger patients with a similar condition.
In analyzing the results of gastric surgery one should differentiate the conditions for which the operations were performed. A convenient grouping separates those patients having operations for malignant disease from those having surgery for benign conditions. For example, some selection is possible in operations for duodenal ulcer; on the other hand, transabdominal exploration is performed in all patients with malignant disease unless there is irrefutable evidence that there is metastatic spread beyond the possibility of cure. Rarely, in malignant disease, has surgical intervention been inadvisable because of the poor condition of the patient. This circumstance, occurring in less than 5 per cent of my personal series, is illustrated by two cases.
Case 1. No operation for hopelessly advanced cancer. A 75-year-old retired farmer . . .