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Langenbeck's Archives of Surgery

, Volume 399, Issue 4, pp 449–459 | Cite as

Pancreatic resection in elderly patients: should it be denied?

  • M. AdhamEmail author
  • L. C. Bredt
  • M. Robert
  • J. Perinel
  • C. Lombard-Bohas
  • T. Ponchon
  • P. J. Valette
Original Article

Abstract

Background

Surgery remains the only potential curative therapy for pancreatic cancer, but compromised physiological reserve and comorbidities may deny pancreatic resection from elderly patients.

Methods

The medical records of all patients who underwent pancreatic resection at our institution (2005–2012) were retrospectively reviewed. Postoperative and long-term outcomes were compared between patients with cutoff age of 70 years.

Results

A total of 228 (66 %) and 116 (34 %) patients were <70 and ≥70 years, respectively. Elderly group had worse ASA scores (P < 0.0001) with higher rates of invasive malignant pathologies (75 vs. 67 %, P = 0.14), mainly pancreatic ductal adenocarcinoma (58.6 vs. 44.7 %, P = 0.01). The most common type of resection was pancreaticoduodenectomy (PD) (59 %), followed by distal pancreatectomy (19.8 %). Mean hospital stay was comparable. Elderly patients had less grade ≥IIIb postoperative complications (12 vs. 20.1 %; P = 0.04) and higher postoperative mortality rates (12.9 vs. 3.9 %; P = 0.04). In multivariable Cox proportional hazards model for postoperative mortality, age ≥70 years (HR, 3.5; 95 % CI, 1.3–9.3), pancreaticoduodenectomy (HR, 12.6; 95 % CI, 1.6–96), and intraoperative blood loss were significant (P = 0.012; P = 0.015, and P = 0.005, respectively). The overall 5-year survival rates for all patients, for patients aged <70 and ≥70 years were 56, 55, and 41 %, respectively (P = 0.003).

Conclusions

Elderly patients are at higher risk of mortality after pancreatic resection than usually reported case series. Nonetheless, elderly patients can undergo pancreatic resection with acceptable 5-year survival results. Our results contribute for a better, informed decision-making for elderly patients and their family.

Keywords

Pancreatectomy Elderly Postoperative mortality Pancreas Resection 

Notes

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • M. Adham
    • 1
    • 5
    Email author
  • L. C. Bredt
    • 1
  • M. Robert
    • 1
  • J. Perinel
    • 1
  • C. Lombard-Bohas
    • 2
  • T. Ponchon
    • 3
  • P. J. Valette
    • 1
    • 4
  1. 1.Department of Hepato-Biliary and Pancreatic Surgery, Lyon Faculty of Medicine—UCBL1Edouard Herriot Hospital—HCLLyonFrance
  2. 2.Department of Medical Digestive Oncology, Lyon Faculty of Medicine—UCBL1Edouard Herriot Hospital—HCLLyonFrance
  3. 3.Department of Hepato-Gastro-Enterology, Lyon Faculty of Medicine—UCBL1Edouard Herriot Hospital—HCLLyonFrance
  4. 4.Department of Digestive Radiology, Lyon Faculty of Medicine—UCBL1Edouard Herriot Hospital—HCLLyonFrance
  5. 5.Unité de Chirurgie HépatoBiliaire et PancréatiqueHôpital Edouard HerriotLyon Cedex 03France

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