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SIOG Surgical ad-hoc Committee

What is the role of the SIOG Surgical ad-hoc Committee (SAHC)? 

The Surgical ad-hoc Committee is an integral part of the SIOG as is surgery an integral part of treatment of senior adults affected by solid malignancies.  As surgery is always evolving so is the SAHC, that is constantly looking for and welcoming new members who share the passion for the care of older patients.  

The times we are living in will be remembered by healthcare providers for the significant ‘contradictions’ in the medical and surgical care of older patients with cancer. On one hand it has been documented how chronological age per se does not contraindicate surgical management at any time in life; on the other hand the vast majority of senior cancer patients are routinely undertreated as a consequence of unproven assumptions. This group of cancer patients is likely to receive suboptimal treatment, either under-treatment as well as over-treatment.  The function of the SAHC is to eliminate the myth that the senior adults are not candidates for surgery and this is to be done within the society and to the rest of the world per se.   

The role of the SAHC inside the International Society of Geriatric Oncology is mainly to establish evidence that could help clinicians in being more aware and proactive about several issues. 

There is a poor understanding of cancer in older patients.  Solid tumors are detrimental at any age as shown for colorectal, breast and pancreatic cancer while surgery is still the number one option to treat solid cancer, above all in senor adults.  When appropriately chosen it could be curative or good palliative procedure.   

 A prejudice about life expectancy is usually preventing cancer specialists whether it be medical, surgical, radiation oncologists or geriatricians to offer the best possible treatment. In the USA a 75-year old male in good health has 18 more years in front of him and 10 years at the age of 82i. The presence of severe comorbidities shrinks life expectancy to 6 and 2 years respectively, which is still a far longer period when compared to the average overall survival of untreated cancer subtypes.  

 Even though there is significant education going on among the surgeons there are several among the community who are hesitant to operate on older patients just because of the chronological age.   Education is the key and there needs to be a valiant effort on the part of the society to show that there is vast available data demonstrating how fit older individuals can successfully undergo most complex invasive procedures with good quality of life outcomes. 

The work of the SAHC began about a decade ago when the PACE studyii proved that the assessment of frailty in every older patients undergoing surgery accurately predicts the operative mortality, morbidity and costs. This was achieved by means of a non-cancer-specific tool (Comprehensive Geriatric Assessment - CGA). In 2014, another SAHC effort, the PREOP studyiii, showed that the complex and time consuming CGA, could be replaced by quick and surgeon-friendly tools like the “Timed Up-and-Go” test and how nutrition has to be optimized to minimize complications. Lately, the SAHC together with the European Society of Surgical Oncology (ESSO), developed the GOSAFE studyiv. The research recently completed accrual and will be soon able to provide prospective, original data about quality of life and functional recovery of older patients undergoing major oncological surgery. The ambitious endpoint of this international prospective registry is to take a real-time-picture of the ultimate outcomes achieved when delivering personalized care to fit, vulnerable and frail cancer patients (including cognitive impairment).  

The role of the SIOG-SAHC is precisely to promote an individualized surgical standard. We realize that personalized treatment does not stand on targeting molecular biomarkers but on putting real-life patients needs as the ultimate goal of our care. 

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What the SIOG-SAHC could be in future? 

The way the SAHC is preparing for the future is primarily to implement the network of clinicians that has been proficiently developed during the process of the PACE, the PREOP and the GOSAFE studies. This group of motivated surgeons with a common goal is open to the challenges that older adults with cancer face and focused on organ-specific malignancies. 

The SAHC members are ambassadors not only in the oncological field in general, but in the organ-specific Scientific Societies. Their role is to promote a more rational and personalized treatment of solid cancer in older patients by collaborating on scientific sessions, guidelines, research studies with the main Scientific Societies (i.e. ESSO, ASCRS, ESCP, SSO). In 2018, the first SIOG-SAHC, ESSO, ESCP, ACS Commission on Cancer join work has been published in the form of expert recommendations on personalized management of older patients with Rectal Cancerv

SAHC members will more and more function as vectors for the knowledge developed by the experience in the SIOG into other scientific groups. 

Further research projects by the SIOG-SAHC, following the GOSAFE, will focus on cancer surgery prehabilitation, biological age predictors, cancer biology in senior adult as few of the fields which requires immediate attention.   

  1. Huisman MG, Ghignone F, Ugolini G, Sidorenkov G, Montroni I, Vigano A, de Liguori Carino N, Farinella E, Cirocchi R, Audisio RA, de Bock GH, van Leeuwen BL. Long-Term Survival and Risk of Institutionalization in Onco-Geriatric Surgical Patients: Long-Term Results of the PREOP Study. J Am Geriatr Soc. 2020 Mar 10. doi: 10.1111/jgs.16384 
  2. Ramello M, Audisio RA. "Understanding older patients: Communication as the key step for a comprehensive approach". EurJSurgOncol.2020 Mar;46(3):301-304. doi: 10.1016/j.ejso.2019.11.002. Epub 2019 Nov 7 
  3. Montroni I, Rostoft S, Spinelli A, Van Leeuwen BL, Ercolani G, Saur NM, Jaklitsch MT, Somasundar PS, de Liguori Carino N, Ghignone F, Foca F, Zingaretti C, Audisio RA, Ugolini G; SIOG surgical task force/ESSO GOSAFE study group. GOSAFE - Geriatric Oncology Surgical Assessment and Functional rEcovery after Surgery: early analysis on 977 patients. J Geriatr Oncol. 2019 Sep 3. pii: S1879-4068(19)30168-7. doi: 10.1016/j.jgo.2019.06.017. [Epub ahead of print] PubMed PMID: 31492572. 
  4. Montroni I, Saur NM Modern, multidisciplinary colorectal cancer care in older patients: Striking a balance between cancer treatment and patient-centered care. Eur J Surg Oncol. 2020 Mar;46(3):299-300 
  5. Plas M, Rutgers A, van der Wal-Huisman H, de Haan JJ, Absalom AR, de Bock GH, van Leeuwen BL. The association between the inflammatory response to surgery and postoperative complications in older patients with cancer; a prospective prognostic factor study. J Geriatr Oncol. 2020 Feb 5. pii: S1879-4068(19)30447-3. 
  6. Saur NM, Montroni I. The opposite of undertreating is frailty screening. Eur J Surg Oncol. 2019 Jan 29. pii: S0748-7983(19)30205-7. doi: 10.1016/j.ejso.2019.01.180. Epub ahead of print. 
  7. Zattoni D, Montroni I, Saur NM, Garutti A, Bacchi Reggiani ML, Galetti C, Calogero P, Tonini V. A Simple Screening Tool to Predict Outcomes in Older Adults Undergoing Emergency General Surgery. J Am Geriatr Soc. 2019 Feb;67(2):309-316.  
  8. Montroni I, Ugolini G, Saur NM, Spinelli A, Rostoft S, Millan M, Wolthuis A, Daniels IR,  Hompes R, Penna MM, Fürst A, Papamichael D, Desai MA, Cascinu S, Gèrard JP, Sun Myint A, Lemmens VEEP, Berho M, Lawler M, De Liguori Carino M, Potenti F, Nanni O, Altini M, Beets G, Rutten H, Winchester D,  Wexner SD and Audisio RA. Personalized Management of Elderly Patients with Rectal Cancer: Expert Recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer. Eur J Surg Oncol. 2018 Aug 15. pii: S0748-7983(18)31272-1 
  9. Plas M, de Haan JJ, van der Wal-Huisman H, Rutgers A, Absalom AR, de Bock GH, van Leeuwen BL. The systemic impact of a surgical procedure in older oncological patients. Eur J Surg Oncol. 2019 Aug;45(8):1403-1409. doi: 10.1016/j.ejso.2019.04.024. Epub 2019 May 3. PubMed PMID: 31104780. 
  10. Huisman MG, Veronese G, Audisio RA, Ugolini G, Montroni I, de Bock GH, van Leeuwen BL; PREOP study group. Poor nutritional status is associated with other geriatric domain impairments and adverse postoperative outcomes in onco-geriatric surgical patients - A multicentre cohort study. Eur J Surg Oncol. 2016 Jul;42(7):1009-17. 
  11. Ghignone F, van Leeuwen BL, Montroni I, Huisman MG, Somasundar P, Cheung KL, Audisio RA, Ugolini G; International Society of Geriatric Oncology (SIOG) Surgical Task Force. The assessment and management of older cancer patients: A SIOG surgical task force survey on surgeons' attitudes. Eur J Surg Oncol. 2015 Dec 17.  
  12. Huisman MG, Audisio RA, Ugolini G, Montroni I, Vigano A, Spiliotis J, Stabilini C, de Liguori Carino N, Farinella E, Stanojevic G, Veering BT, Reed MW, Somasundar PS, de Bock GH, van Leeuwen BL. Screening for predictors of adverse outcome in onco-geriatric surgical patients: A multicenter prospective cohort study. Eur J Surg Oncol. 2015 Jul;41(7):844-51.