PROGNOSTIC FACTORS OF DIGESTIVE ONCOLOGICAL EMERGENCIES IN THE ELDERLY: CASE STUDY

The number of patients with digestive cancers, aged overof 65-year-olds admitted in emergency is clearly increasing.The purpose of this study was to assess the prognosis factors care improvement and management of elderly before, during and after surgery, the predictors of mortality and morbidity following emergency oncological digestive surgery in patients aged 65 years and older, the therapeutic management and study survival, prevention and surveillance, to compare them with the data of the literature.Our study included 86 patients admitted to visceral emergencies for an urgent syndrome revealing or complicating a primary or secondary digestive cancer, and who required immediate surgical intervention and who had stayed at the 33 surgical resuscitation department in the IBN-ROCHD UNIVERSITY HOSPITAL CENTER (UHC) of Casablanca on a duration of 4 years from January 10, 2016 to May 05, 2019.Several data were entered on Excel and analyzed using the SPSS version 20 software:

·        Epidemiological, concerning age and gender

·        Clinics including risk factors, history, general condition of the patient and clinical examination data

·        Para-clinical, interesting biological assessments, and morphological examinations

·        Medical and surgical therapeutics

·        Postoperative follow-up

·        Treatment results.

The most frequent sites were rated in order of increasing frequency: Colo-rectal (40.7%),small intestine(22.1%), pancreas (10%), and biliary tract (8.1%).72.09 % of patients were between 65 and 75 years, while only 27.91 % were 76 years old and over. This study includes 44 women and 42 men with a sex ratio of 0.96. The evolution method was mostly acute in 95% of cases. Our patients have consulted for urgent clinical presentations mainly occlusive syndrome noted in 59% of patients.The surgery was done in 62% for palliative indication: 55% were operated for an ostomy discharge, 32% for a palliative resection, 17% for an ostomy supply and 13% for a digestive bypass. Postoperative outcomes were 35% morbidity and 48% mortality. The main cause of death was hemodynamic instability in 34% of cases.Thanks to multivariate statistical analysis four factors were deduced significantly related to mortality: Morbidity the CONUT score, hypoalbuminemia, and admission for a Bowel obstruction.In our context, digestive cancers in elderly are a frequent reason for emergency consultation. The majority of surgical interventions were palliative and the postoperative outcome is marked by high morbidity and mortality.Small changes in morbidity and mortality could have a significant impact, both on the results, on the high cost of prolonged hospitalization,and on the incidence of perioperative complications. This will require a good knowledge of the predictive mortality factors both by the anesthetist and by the visceralist surgeon.