Pancreatic resection in elderly patients: should it be denied?
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Surgery remains the only potential curative therapy for pancreatic cancer, but compromised physiological reserve and comorbidities may deny pancreatic resection from elderly patients.
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.
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).
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.
KeywordsPancreatectomy Elderly Postoperative mortality Pancreas Resection
Conflicts of interest
- 1.World Health Organization: Regional Office for Europe. The European Health Report 2012: charting the way to well-being 2012.Google Scholar
- 15.DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244(6):931–937, discussion 937–9PubMedCentralPubMedCrossRefGoogle Scholar
- 19.Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 761–8.Google Scholar
- 20.Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, 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 680–8.Google Scholar
- 31.Turrini O, Paye F, Bachellier P, Sauvanet A, Cunha AS, Le Treut YP, et al (2013) Pancreatectomy for adenocarcinoma in elderly patients: postoperative outcomes and long term results: a study of the French Surgical Association. European Journal of Surgical Oncology [Internet]. Elsevier Ltd; 39(2):171–8. Available from: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=22999411&retmode=ref&cmd=prlinks