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Perioperative and long-term outcomes after pancreaticoduodenectomy in elderly patients 80 years of age and older

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Abstract

Purpose

Although a pancreaticoduodenectomy (PD) has been recently regarded as a safe surgical procedure at high-volume centers, the efficacy of PD for patients 80 years of age and older is controversial. The aim of this study was to evaluate the perioperative and long-term outcomes following PD in patients 80 years of age and older.

Methods

Elderly patients 80 years of age and older who underwent PD between 2001 and 2009 were identified. The perioperative and long-term outcomes were compared with patients younger than 80 years of age.

Results

Of 561 total patients, 22 patients (3.9 %) were 80 years of age or older. Mortality occurred in one patient (4.5 %). Postoperative major complications (Clavien–Dindo classification ≥grade III) occurred in six patients (27.3 %) in this group, which was significantly higher than in patients younger than 80 years of age (P = 0.008). The survival of the elderly patients undergoing PD for pancreatic cancer was significantly shorter than that for the same patient group with other diseases (median survival, 13 versus 82 months; P = 0.014). Only one elderly patient with pancreatic cancer survived more than 3 years.

Conclusions

PD for pancreatic cancer in patients aged 80 and older should be carefully selected, because it is associated with a higher incidence of severe postoperative complications and a small change of long-term survival.

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References

  1. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H (2000) Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 232(6):786–795

    Article  PubMed  CAS  Google Scholar 

  2. DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244(6):931–937. doi:10.1097/01.sla.0000246856.03918.9a, discussion 937–939

    Article  PubMed  Google Scholar 

  3. DiCarlo V, Balzano G, Zerbi A, Villa E (1998) Pancreatic cancer resection in elderly patients. Br J Surg 85(5):607–610. doi:10.1046/j.1365-2168.1998.00685.x

    Article  PubMed  CAS  Google Scholar 

  4. Petrowsky H, Clavien PA (2005) Should we deny surgery for malignant hepato-pancreatico-biliary tumors to elderly patients? World J Surg 29(9):1093–1100. doi:10.1007/s00268-005-1130-6

    Article  PubMed  Google Scholar 

  5. Ballarin R, Spaggiari M, Di Benedetto F, Montalti R, Masetti M, De Ruvo N, Romano A, Guerrini GP, De Blasiis MG, Gerunda GE (2009) Do not deny pancreatic resection to elderly patients. J Gastrointest Surg 13(2):341–348. doi:10.1007/s11605-008-0601-0

    Article  PubMed  Google Scholar 

  6. Finlayson E, Fan Z, Birkmeyer JD (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205(6):729–734. doi:10.1016/j.jamcollsurg.2007.06.307

    Article  PubMed  Google Scholar 

  7. Riall TS, Reddy DM, Nealon WH, Goodwin JS (2008) The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 248(3):459–467. doi:10.1097/SLA.0b013e318185e1b3

    PubMed  Google Scholar 

  8. Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, Sauter PK, Coleman J, Ord SE, Grochow LB, Abrams RA, Pitt HA (1998) Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 2(3):207–216

    Article  PubMed  CAS  Google Scholar 

  9. Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, Riall TS, Yeo CJ (2006) Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 10(3):347–356. doi:10.1016/j.gassur.2005.12.014

    Article  PubMed  Google Scholar 

  10. Khan S, Sclabas G, Lombardo KR, Sarr MG, Nagorney D, Kendrick ML, Donohue JH, Que FG, Farnell MB (2010) Pancreatoduodenectomy for ductal adenocarcinoma in the very elderly; is it safe and justified? J Gastrointest Surg 14(11):1826–1831. doi:10.1007/s11605-010-1294-8

    Article  PubMed  Google Scholar 

  11. Tani M, Kawai M, Hirono S, Ina S, Miyazawa M, Nishioka R, Shimizu A, Uchiyama K, Yamaue H (2009) A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age. J Hepatobiliary Pancreat Surg 16(5):675–680. doi:10.1007/s00534-009-0106-6

    Article  PubMed  Google Scholar 

  12. Hatzaras I, Schmidt C, Klemanski D, Muscarella P, Melvin WS, Ellison EC, Bloomston M (2011) Pancreatic resection in the octogenarian: a safe option for pancreatic malignancy. J Am Coll Surg 212(3):373–377. doi:10.1016/j.jamcollsurg.2010.10.015

    Article  PubMed  Google Scholar 

  13. Riall TS (2009) What is the effect of age on pancreatic resection? Adv Surg 43:233–249

    Article  PubMed  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  Google Scholar 

  15. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, Definition ISGoPF (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13. doi:10.1016/j.surg.2005.05.001

    Article  PubMed  Google Scholar 

  16. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768. doi:10.1016/j.surg.2007.05.005

    Article  PubMed  Google Scholar 

  17. Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, Doi R, Monden M, Hatori T, Tanaka M, Shimada M, Kanemitsu K (2009) A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 101(6):908–915. doi:10.1038/sj.bjc.6605256

    Article  PubMed  CAS  Google Scholar 

  18. Sulpice L, Rayar M, D’Halluin PN, Harnoy Y, Merdrignac A, Bretagne JF, Meunier B, Boudjema K (2012) Impact of age over 75 years on outcomes after pancreaticoduodenectomy. J Surg Res 3. doi:10.1016/j.jss.2012.03.075

  19. Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13(8):1035–1046. doi:10.1245/aso.2006.08.011

    Article  PubMed  Google Scholar 

  20. Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, Abdalla EK, Crane CH, Wolff RA, Varadhachary GR, Hwang RF (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 206(5):833–846. doi:10.1016/j.jamcollsurg.2007.12.020, discussion 846–838

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by a grant-in-aid for cancer research from the Ministry of Health, Welfare and Labor of Japan (21-7-5).

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None.

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Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1Tsukiji; Chuo-ku, Tokyo, 104-0045, Japan

    Seiji Oguro, Kazuaki Shimada, Yoji Kishi, Satoshi Nara, Minoru Esaki & Tomoo Kosuge

  2. Juntendo University Graduate School of Medicine, Tokyo, Japan

    Seiji Oguro & Tomoo Kosuge

Authors
  1. Seiji Oguro
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  2. Kazuaki Shimada
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  3. Yoji Kishi
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  4. Satoshi Nara
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  5. Minoru Esaki
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  6. Tomoo Kosuge
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Corresponding author

Correspondence to Kazuaki Shimada.

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Oguro, S., Shimada, K., Kishi, Y. et al. Perioperative and long-term outcomes after pancreaticoduodenectomy in elderly patients 80 years of age and older. Langenbecks Arch Surg 398, 531–538 (2013). https://doi.org/10.1007/s00423-013-1072-7

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  • DOI: https://doi.org/10.1007/s00423-013-1072-7

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