Langenbeck's Archives of Surgery

, Volume 398, Issue 4, pp 539–545 | Cite as

Surgical outcomes of pancreaticoduodenectomy for periampullary tumors in elderly patients

  • Yo-ichi Yamashita
  • Ken Shirabe
  • Eiji Tsujita
  • Kazuki Takeishi
  • Tetsuo Ikeda
  • Tomoharu Yoshizumi
  • Yoshinari Furukawa
  • Teruyoshi Ishida
  • Yoshihiko Maehara
Original Article



Pancreaticoduodenectomy (PD) is an aggressive surgery with considerable operative risks, but offers the only chance for cure in patients with periampullary tumors. A growing number of elderly patients are being offered PD because of the aging of populations in developed countries. We examined surgical outcomes of PD in patients aged 75 years and older (≥75 years).


A retrospective cohort study was performed in 65 consecutive patients who underwent PD for periampullary tumors at a single medical center during the 5 years from 2006 to 2010. We analyzed surgical outcomes such as mortality and morbidity after PD in patients aged ≥75 years (n = 21) compared to those in patients aged <75 years (n = 44).


The positive rate of comorbidities such as hypertension was significantly higher in patients aged ≥75 years than in patients aged <75 years (76 vs. 48 %; p = 0.03). The incidence of wound infection was significantly higher in patients aged ≥75 years than in patients aged <75 years (19 vs. 0 %; p < 0.01). However, there was no significant difference in the mortality rate (0 vs. 2 %; p = 0.49) or the overall morbidity rate (33 vs. 32 %; p = 0.90). There was no significant difference in changes in body weight or serum albumin levels during the 3 months after PD between the two groups, but the recovery of serum prealbumin levels from 1 to 3 months after PD in patients aged ≥75 years was significantly delayed compared to that in patients aged <75 years (p = 0.04). There was no statistically significant difference in long-term survival between the two groups.


Advanced age alone should not discourage surgeons from offering PD, although nutritional supports after PD for elderly patients aged ≥75 years are needed.


Pancreaticoduodenectomy (PD) Elderly patients Mortality and morbidity Wound infection Prealbumin 


  1. 1.
    Ministry of Internal Affairs and Communications Department of Statistics. Accessed 6 July 2012
  2. 2.
    Ishikawa A, Beppu M, Sato R (2006) Population statistics of Japan 2006. Yamato-sogo. Tokyo, JapanGoogle Scholar
  3. 3.
    Etzioni DA, Liu JH, Maggard MA, Ko CY (2003) The aging population and its impact on the surgery workforce. Ann Surg 238:170–7PubMedGoogle Scholar
  4. 4.
    Whipple AO (1945) Pancreaticoduodenectomy for islet carcinoma: a five-year follow-up. Ann Surg 121:847–52PubMedCrossRefGoogle Scholar
  5. 5.
    Yeo CJ et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257, discussion 257–60PubMedCrossRefGoogle Scholar
  6. 6.
    Neoptolemos JP, Russell RC, Bramhall S, Theis B (1997) Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg 84:1370–6PubMedCrossRefGoogle Scholar
  7. 7.
    Conlon KC et al (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234:487–493, discussion 493–4PubMedCrossRefGoogle Scholar
  8. 8.
    Yeo CJ et al (2002) Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 236:355–366, discussion 366–8PubMedCrossRefGoogle Scholar
  9. 9.
    Brozzetti S, Mazzoni G, Miccini M, Puma F, De Angelis M, Cassini D, Bettelli E, Tocchi A, Cavallaro A (2006) Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg 141:137–42PubMedCrossRefGoogle Scholar
  10. 10.
    Lee MK, Dinorcia J, Reavey PL, Holden MM, Genkinger JM, Lee JA, Schrope BA, Chabot JA, Allendorf JD (2010) Pancreaticoduodenectomy can be performed safely in patients aged 80 years and older. J Gastrointest Surg 14:1838–46PubMedCrossRefGoogle Scholar
  11. 11.
    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 14:1826–31PubMedCrossRefGoogle Scholar
  12. 12.
    DiCarlo V, Balzano G, Zerbi A, Villa E (1998) Pancreatic cancer resection in elderly patients. Br J Surg 85:607–10PubMedCrossRefGoogle Scholar
  13. 13.
    Fong Y, Blumgart LH, Fortner JG, Brennan MF (1995) Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg 222:426–434, discussion 434–7PubMedGoogle Scholar
  14. 14.
    Yamada S, Shimada M, Utsunomiya T, Morine Y, Imura S, Ikemoto T, Mori H, Kanamoto M, Hanaoka J, Iwahashi S, Saitoh Y (2012) Surgical results of pancreatoduodenectomy in elderly patients. Surg Today 42(9):857–862PubMedCrossRefGoogle Scholar
  15. 15.
    Tani M et al (2009) A pancreaticoduodenectomy is acceptable for periampullary tumors in the elderly, even in patients over 80 years of age. J Hepatobiliary Pancreat Surg 16:675–680, Epub 2009 Apr 22PubMedCrossRefGoogle Scholar
  16. 16.
    Ito Y, Kenmochi T, Irino T, Egawa T, Hayashi S, Nagashima A, Kitagawa Y (2011) The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol 9:102PubMedCrossRefGoogle Scholar
  17. 17.
    Whipple AO, Parsons WB, Mullins CR (1935) Treatment of carcinoma of the ampulla of Vater. Ann Surg 102:763–79PubMedCrossRefGoogle Scholar
  18. 18.
    Watson K (1944) Carcinoma of the ampulla of Vater. Successful radical resection. Br J Surg 31:368–373CrossRefGoogle Scholar
  19. 19.
    Hayashibe A, Kameyama M, Shinbo M, Makimoto S (2007) The surgical procedure and clinical results of subtotal stomach preserving pancreaticoduodenectomy (SSPPD) in comparison with pylorus preserving pancreaticoduodenectomy (PPPD). J Surg Oncol 95:106–9PubMedCrossRefGoogle Scholar
  20. 20.
    Traverso LW, Longmire WP Jr (1978) Preservation of the pylorus in pancreaticoduodenectomy. Surg Gynecol Obstet 146:959–62PubMedGoogle Scholar
  21. 21.
    Clavien PA et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196PubMedCrossRefGoogle Scholar
  22. 22.
    Bassi C, International Study Group on Pancreatic Fistula Definition et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRefGoogle Scholar
  23. 23.
    Koch M et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688PubMedCrossRefGoogle Scholar
  24. 24.
    Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768PubMedCrossRefGoogle Scholar
  25. 25.
    Finlayson E, Fan Z, Birkmeyer JD (2007) Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg 205:729–34PubMedCrossRefGoogle Scholar
  26. 26.
    Lightner AM, Glasgow RE, Jordan TH, Krassner AD, Way LW, Mulvihill SJ, Kirkwood KS (2004) Pancreatic resection in the elderly. J Am Coll Surg 198:697–706PubMedCrossRefGoogle Scholar
  27. 27.
    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 2:207–16PubMedCrossRefGoogle Scholar
  28. 28.
    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 10:347–56PubMedCrossRefGoogle Scholar
  29. 29.
    Bathe OF, Caldera H, Hamilton KL, Franceschi D, Sleeman D, Livingstone AS, Levi JU (2001) Diminished benefit from resection of cancer of the head of the pancreas in patients of advanced age. J Surg Oncol 77:115–22PubMedCrossRefGoogle Scholar
  30. 30.
    dos Santos Junqueira JC et al (2003) Nutritional risk factors for postoperative complications in Brazilian elderly patients undergoing major elective surgery. Nutrition 19:321–326PubMedCrossRefGoogle Scholar
  31. 31.
    Park JS, Chung HK, Hwang HK, Kim JK, Yoon DS (2012) Postoperative nutritional effects of early enteral feeding compared with total parental nutrition in pancreaticoduodectomy patients: a prospective, randomized study. J Korean Med Sci 27:261–7PubMedCrossRefGoogle Scholar
  32. 32.
    Yermilov I, Bentrem D, Sekeris E, Jain S, Maggard MA, Ko CY, Tomlinson JS (2009) Readmissions following pancreaticoduodenectomy for pancreas cancer: a population-based appraisal. Ann Surg Oncol 16:554–61PubMedCrossRefGoogle Scholar
  33. 33.
    Aloia TA, Lee JE, Vauthey JN, Abdalla EK, Wolff RA, Varadhachary GR, Abbruzzese JL, Crane CH, Evans DB, Pisters PW (2007) Delayed recovery after pancreaticoduodenectomy: a major factor impairing the delivery of adjuvant therapy? J Am Coll Surg 204:347–55PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Yo-ichi Yamashita
    • 1
    • 2
  • Ken Shirabe
    • 2
  • Eiji Tsujita
    • 1
  • Kazuki Takeishi
    • 1
  • Tetsuo Ikeda
    • 2
  • Tomoharu Yoshizumi
    • 2
  • Yoshinari Furukawa
    • 3
  • Teruyoshi Ishida
    • 1
  • Yoshihiko Maehara
    • 2
  1. 1.Department of SurgeryHiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalHiroshimaJapan
  2. 2.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  3. 3.Department of GastroenterologyHiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalHiroshimaJapan

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