Pancreatic Tumors

  • Sergio Alfieri
  • Fausto Rosa
  • Dario Di Miceli
  • Giovanni Battista Doglietto
Chapter

Abstract

Pancreatic adenocarcinoma occurs mainly after 60 years of age. Its prognosis remains extremely poor despite modest improvements in recent decades. The aging population will result in a rise in incidence of pancreatic adenocarcinoma within the next few years. Thus, the management of pancreatic cancer in the elderly population is becoming increasingly relevant. Older cancer patients represent a heterogeneous group with different biological, functional, and psychosocial characteristics. These characteristics in each individual can modify the usual management of the disease, including pharmacokinetic and pharmacodynamic changes, polypharmacy, performance status, comorbidities, and organ dysfunction. However, the biological age, not the chronological age of the patient, should be the limiting factor in determining the most appropriate treatment. Unfortunately, despite the increased incidence of this pathology in older patients, they are underrepresented in clinical trials. Thus, the management of older patients is determined by the extrapolation of results from studies performed in younger patients.

Keywords

Pancreatic tumors Elderly Management Treatment Pancreatic cancer 

References

  1. 1.
    Dimick JB, Diener-West M, Lipsett PA. Negative results of randomized clinical trials published in the surgical literature: equivalency or error? Arch Surg. 2001;136:796–800.CrossRefGoogle Scholar
  2. 2.
    Rabeneck L, Davila JA, Thompson M, et al. Outcomes in elderly patients following surgery for colorectal cancer in the veterans affairs health care system. R Aliment Pharmacol Ther. 2004;5:1115–24.CrossRefGoogle Scholar
  3. 3.
    World population ageing. United Nations: Department of Economic and Social Affairs Population Division. http://www.un.org/esa/population. Accessed 10 Sept 2013.
  4. 4.
    National Centre for Health Statistics. Health, United States. With chartbook on trends in the Health of Americans. Hyattsville: National Centre for Health Statistics; 2006. p. 176.Google Scholar
  5. 5.
    Federal Statistical Office. Germany’s Population by 2050. Results of the 11th Coordinated Population Projection. Wiesbaden: Federal Statistical Office; 2006. p. 37.Google Scholar
  6. 6.
    Vladychenko A. Recent demographic developments in Europe. Strasbourg: Council of Europe Publishing; 2005. http://www.coe.int/t/e/social_cohesion/population/Demo2004EN.pdf. Accessed 10 Sept 2013.
  7. 7.
    Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2008. Bethesda, MD: National Cancer Institute. Based on November 2010 SEER data submission, posted to the SEERWeb site, 2011. http://seer.cancer.gov/csr/1975_2008/. Accessed 10 Sept 2013.
  8. 8.
    Gooiker GA, van Gijn W, Wouters MWJM, et al. Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg. 2011;98:485–94.CrossRefGoogle Scholar
  9. 9.
    Williams DB, Carrillo RG, Traad EA, et al. Determinants of operative mortality in octogenarians undergoing coronary bypass. Ann Thorac Surg. 1995;60:1038–43.CrossRefGoogle Scholar
  10. 10.
    Katz NM, Chase GA. Risks of cardiac operations for elderly patients: reduction of the age factor. Ann Thorac Surg. 1997;63:1309–14.CrossRefGoogle Scholar
  11. 11.
    Sollano JA, Rose EA, Williams DL, et al. Cost-effectiveness of coronary artery bypass surgery in octogenarians. Ann Surg. 1998;228:297–306.CrossRefGoogle Scholar
  12. 12.
    Nehler MR, Taylor LM, Moneta GL, et al. Indications for operation for infrarenal abdominal aortic aneurysms: current guidelines. Semin Vasc Surg. 1995;8:108–14.PubMedGoogle Scholar
  13. 13.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65:5–29.  https://doi.org/10.3322/caac.21254.CrossRefGoogle Scholar
  14. 14.
    Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31:128–36.  https://doi.org/10.1053/j.seminoncol.2003.12.024.CrossRefPubMedGoogle Scholar
  15. 15.
    Altekruse SF, Kosary CL, Krapcho M, Neyman N, Aminou R, Waldron W, Ruhl J, Howlader N, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Cronin K, Chen HS, Feuer EJ, Stinchcomb DG, Edwards BK. SEER cancer statistics review, 1975–2007. Bethesda: National Cancer Institute; 2010. http://seer.cancer.gov/csr/1975_2007/ Google Scholar
  16. 16.
    Lasry A, Ben-Neriah Y. Senescence-associated inflammatory responses: aging and cancer perspectives. Trends Immunol. 2015;36:217–28.  https://doi.org/10.1016/j.it.2015.02.009.CrossRefPubMedGoogle Scholar
  17. 17.
    Grimes A, Chandra SB. Significance of cellular senescence in aging and cancer. Cancer Res Treat. 2009;41:187–95.  https://doi.org/10.4143/crt.2009.41.4.187.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Amedei A, Niccolai E, Benagiano M, Della Bella C, Cianchi F, Bechi P, Taddei A, Bencini L, Farsi M, Cappello P, Prisco D, Novelli F, D’Elios MM. Ex vivo analysis of pancreatic cancer-infiltrating T lymphocytes reveals that ENO-specific Tregs accumulate in tumor tissue and inhibit Th1/Th17 effector cell functions. Cancer Immunol Immunother. 2013;62:1249–60.  https://doi.org/10.1007/s00262-013-1429-3.CrossRefPubMedGoogle Scholar
  19. 19.
    Amedei A, Niccolai E, Prisco D. Pancreatic cancer: role of the immune system in cancer progression and vaccine-based immunotherapy. Hum Vaccin Immunother. 2014;10:3354–68.  https://doi.org/10.4161/hv.34392.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Bazhin AV, Shevchenko I, Umansky V, Werner J, Karakhanova S. Two immune faces of pancreatic adenocarcinoma: possible implication for immunotherapy. Cancer Immunol Immunother. 2014;63:59–65.  https://doi.org/10.1007/s00262-013-1485-8.CrossRefPubMedGoogle Scholar
  21. 21.
    Kamisawa T, Yuyang T, Egawa N, Ishiwata J, Tsuruta K, Okamoto A, Koike M. Characteristics of pancreatic carcinoma in the elderly. Int J Pancreatol. 1998;24:31–4.PubMedGoogle Scholar
  22. 22.
    Sato Y, Nio Y, Song MM, Sumi S, Hirahara N, Minari Y, Tamura K. p53 protein expression as prognostic factor in human pancreatic cancer. Anticancer Res. 1997;17:2779–88.PubMedGoogle Scholar
  23. 23.
    Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G. Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol. 2007;25:1858–69.  https://doi.org/10.1200/JCO.2006.10.4208.CrossRefPubMedGoogle Scholar
  24. 24.
    Quaglia A, Tavilla A, Shack L, Brenner H, Janssen-Heijnen M, Allemani C, Colonna M, Grande E, Grosclaude P, Vercelli M. The cancer survival gap between elderly and middle-aged patients in Europe is widening. Eur J Cancer. 2009;45:1006–16.  https://doi.org/10.1016/j.ejca.2008.11.028.CrossRefPubMedGoogle Scholar
  25. 25.
    Parmar AD, Vargas GM, Tamirisa NP, Sheffield KM, Riall TS. Trajectory of care and use of multimodality therapy in older patients with pancreatic adenocarcinoma. Surgery. 2014;156:280–9.  https://doi.org/10.1016/j.surg.2014.03.001.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Hutchins LF, Unger JM, Crowley JJ, Coltman CA, Albain KS. Underrepresentation of patients 65 years of age or older in cancer treatment trials. N Engl J Med. 1999;341:2061–7.  https://doi.org/10.1056/NEJM199912303412706.CrossRefPubMedGoogle Scholar
  27. 27.
    Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol. 2004;22:4626–31.  https://doi.org/10.1200/JCO.2004.02.175.CrossRefPubMedGoogle Scholar
  28. 28.
    Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000;5:224–37.  https://doi.org/10.1634/theoncologist.5-3-224.CrossRefPubMedGoogle Scholar
  29. 29.
    Balducci L, Extermann M. Cancer and aging. An evolving panorama. Hematol Oncol Clin North Am. 2000;14:1–16.  https://doi.org/10.1016/S0889-8588(05)70274-4.CrossRefPubMedGoogle Scholar
  30. 30.
    Lamont EB, Schilsky RL, He Y, Muss H, Cohen HJ, Hurria A, Meilleur A, Kindler HL, Venook A, Lilenbaum R, Niell H, Goldberg RM, Joffe S. Generalizability of trial results to elderly medicare patients with advanced solid tumors (Alliance 70802). J Natl Cancer Inst. 2015;107:336.  https://doi.org/10.1093/jnci/dju336.CrossRefPubMedGoogle Scholar
  31. 31.
    Sener SF, Fremgen A, Menck HR, et al. Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer Database. J Am Coll Surg. 1999;189:1–7.CrossRefGoogle Scholar
  32. 32.
    Niederhuber JE, Brennan MF, Menck HR. The National Cancer Database report on pancreatic cancer. Cancer. 1995;76:1671–6.CrossRefGoogle Scholar
  33. 33.
    Hatori T. A clinicopathologic study of ductal adenocarcinoma of the head of the pancreas in aged patients 70 years and older. J Jpn Panc Soc. 1993;8:506–15.Google Scholar
  34. 34.
    Riall TS, Reddy DM, Nealon WH, Goodwin JS. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg. 2008;248(3):459–67.  https://doi.org/10.1097/SLA.0b013e318185e1b3.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Ferfuson G. Pancreatico-duodenectomy: operation on two elderly patients. Br Med J. 1954. Riall TS. What is the effect of age on pancreatic resection? Adv Surg. 2009;43:233–49.  https://doi.org/10.1016/j.yasu.2009.02.004.CrossRefGoogle Scholar
  36. 36.
    Riall TS, Sheffield KM, Kuo YF, Townsend CM, Goodwin JS. Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality. J Am Geriatr Soc. 2011;59:647–54.  https://doi.org/10.1111/j.1532-5415.2011.03353.x.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, Sauter PK, Coleman J, Ord SE, Grochow LB, Abrams RA, Pitt HA. Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg. 1998;2:207–16.  https://doi.org/10.1016/S1091-255X(98)80014-0.CrossRefPubMedGoogle Scholar
  38. 38.
    Meguid RA, Ahuja N, Chang DC. What constitutes a “high volume” hospital for pancreatic resection? J Am Coll Surg. 2008;206:622.e1–9.  https://doi.org/10.1016/j.jamcollsurg.2007.11.011.CrossRefGoogle Scholar
  39. 39.
    Makary MA, Winter JM, Cameron JL, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10(3):347–56.  https://doi.org/10.1016/j.gassur.2005.12.014.CrossRefPubMedGoogle Scholar
  40. 40.
    Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg. 1995;222:638–45.  https://doi.org/10.1097/00000658-199511000-00006.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Finlayson E, Fan Z, Birkmeyer JD. Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg. 2007;205(6):729–34.  https://doi.org/10.1016/j.jamcollsurg.2007.06.307.CrossRefPubMedGoogle Scholar
  42. 42.
    Hodul P, Tansey J, Golts E, et al. Age is not a contraindication to pancreaticoduodenectomy. Am Surg. 2001;67(3):270–5.PubMedGoogle Scholar
  43. 43.
    Ito Y, Kenmochi T, Irino T, et al. The impact of surgical outcome after pancreaticoduodenectomy in elderly patients. World J Surg Oncol. 2011;9:102.  https://doi.org/10.1186/1477-7819-9-102.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Bathe OF, Levi D, Caldera H, et al. Radical resection of periampullary tumors in the elderly: evaluation of long-term results. World J Surg. 2000;24(3):353–8.  https://doi.org/10.1007/s002689910056.CrossRefPubMedGoogle Scholar
  45. 45.
    Aloia TA, Lee JE, Vauthey JN, Abdalla EK, Wolff RA, Varadhachary GR, Abbruzzese JL, Crane CH, Evans DB, Pisters PW. Delayed recovery after pancreaticoduodenectomy: a major factor impairing the delivery of adjuvant therapy? J Am Coll Surg. 2007;204:347–55.  https://doi.org/10.1016/j.jamcollsurg.2006.12.011.CrossRefPubMedGoogle Scholar
  46. 46.
    Targarona J, Callacondo D, Pino C, Rodriguez C, Coayla G, Garatea R, Barreda C, Barreda L. Impact of duodenopancreatectomy in elder patients. Rev Gastroenterol Peru. 2013;33:217–22.PubMedGoogle Scholar
  47. 47.
    Li D, Xie K, Wolff R, Abbruzzese JL. Pancreatic cancer. Lancet. 2004;363:1049–57.  https://doi.org/10.1016/S0140-6736(04)15841-8.CrossRefPubMedGoogle Scholar
  48. 48.
    Shinchi H, Takao S, Noma H, Matsuo Y, Mataki Y, Mori S, Aikou T. Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2002;53:146–50.  https://doi.org/10.1016/S0360-3016(01)02806-1.CrossRefPubMedGoogle Scholar
  49. 49.
    Sultana A, Tudur Smith C, Cunningham D, Starling N, Tait D, Neoptolemos JP, Ghaneh P. Systematic review, including metaanalyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy. Br J Cancer. 2007;96:1183–90.  https://doi.org/10.1038/sj.bjc.6603719.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Moertel CG, Frytak S, Hahn RG, O’Connell MJ, Reitemeier RJ, Rubin J, Schutt AJ, Weiland LH, Childs DS, Holbrook MA, Lavin PT, Livstone E, Spiro H, Knowlton A, Kalser M, Barkin J, Lessner H, Mann-Kaplan R, Ramming K, Douglas HO, Thomas P, Nave H, Bateman J, Lokich J, Brooks J, Chaffey J, Corson JM, Zamcheck N, Novak JW. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer. 1981;48:1705–10.  https://doi.org/10.1002/1097-0142(19811015)48:8<1705.CrossRefPubMedGoogle Scholar
  51. 51.
    Krzyzanowska MK, Weeks JC, Earle CC. Treatment of locally advanced pancreatic cancer in the real world: population-based practices and effectiveness. J Clin Oncol. 2003;21:3409–14.  https://doi.org/10.1200/JCO.2003.03.007.CrossRefPubMedGoogle Scholar
  52. 52.
    Morizane C, Okusaka T, Ito Y, Ueno H, Ikeda M, Takezako Y, Kagami Y, Ikeda H. Chemoradiotherapy for locally advanced pancreatic carcinoma in elderly patients. Oncology. 2005;68:432–7.  https://doi.org/10.1159/000086985.CrossRefPubMedGoogle Scholar
  53. 53.
    Miyamoto DT, Mamon HJ, Ryan DP, Willett CG, Ancukiewicz M, Kobayashi WK, Blaszkowsky L, Fernandez-del Castillo C, Hong TS. Outcomes and tolerability of chemoradiation therapy for pancreatic cancer patients aged 75 years or older. Int J Radiat Oncol Biol Phys. 2010;77:1171–7.  https://doi.org/10.1016/j.ijrobp.2009.06.020.CrossRefPubMedGoogle Scholar
  54. 54.
    Rwigema JC, Parikh SD, Heron DE, Howell M, Zeh H, Moser AJ, Bahary N, Quinn A, Burton SA. Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol. 2011;34:63–9.  https://doi.org/10.1097/COC.0b013e3181d270b4.CrossRefPubMedGoogle Scholar
  55. 55.
    Chang DT, Schellenberg D, Shen J, Kim J, Goodman KA, Fisher GA, Ford JM, Desser T, Quon A, Koong AC. Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer. 2009;115:665–72.  https://doi.org/10.1002/cncr.24059.CrossRefPubMedGoogle Scholar
  56. 56.
    Kim CH, Ling DC, Wegner RE, Flickinger JC, Heron DE, Zeh H, Moser AJ, Burton SA. Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients. Radiat Oncol. 2013;8:240.  https://doi.org/10.1186/1748-717X-8-240.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Chauffert B, Mornex F, Bonnetain F, Rougier P, Mariette C, Bouché O, Bosset JF, Aparicio T, Mineur L, Azzedine A, Hammel P, Butel J, Stremsdoerfer N, Maingon P, Bedenne L. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol. 2008;19:1592–9.  https://doi.org/10.1093/annonc/mdn281.CrossRefPubMedGoogle Scholar
  58. 58.
    Loehrer PJ, Feng Y, Cardenes H, Wagner L, Brell JM, Cella D, Flynn P, Ramanathan RK, Crane CH, Alberts SR, Benson AB. Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. J Clin Oncol. 2011;29:4105–12.  https://doi.org/10.1200/JCO.2011.34.8904.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.  https://doi.org/10.1245/ASO.2006.08.011.CrossRefPubMedGoogle Scholar
  60. 60.
    Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, Abdalla EK, Crane CH, Wolff RA, Varadhachary GR, Hwang RF. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206:833–846.; discussion 846–8.  https://doi.org/10.1016/j.jamcollsurg.2007.12.020.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Lim KH, Chung E, Khan A, Cao D, Linehan D, Ben-Josef E, Wang-Gillam A. Neoadjuvant therapy of pancreatic cancer: the emerging paradigm? Oncologist. 2012;17:192–200.  https://doi.org/10.1634/theoncologist.2011-0268.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Liao WC, Chien KL, Lin YL, Wu MS, Lin JT, Wang HP, Tu YK. Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol. 2013;14:1095–103.  https://doi.org/10.1016/S1470-2045(13)70388-7.CrossRefPubMedGoogle Scholar
  63. 63.
    Miura JT, Krepline AN, Duelge KD, George B, Ritch PS, Erickson B, Thomas JP, Mahmoud A, Quebbeman EJ, Turaga K, Johnston FM, Christians KK, Gamblin TC, Evans DB, Tsai S. Neoadjuvant therapy for pancreatic cancer in patients older than age 75. J Clin Oncol. 2014;32(Suppl 3):287.CrossRefGoogle Scholar
  64. 64.
    Wyse JM, Chen YI, Sahai AV. Celiac plexus neurolysis in the management of unresectable pancreatic cancer: when and how? World J Gastroenterol. 2014;20:2186–92.  https://doi.org/10.3748/wjg.v20.i9.2186.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Ferrell BA, Ferrell BR, Osterweil D. Pain in the nursing home. J Am Geriatr Soc. 1990;38:409–14.  https://doi.org/10.1111/j.1532-5415.1990.tb03538.x.CrossRefPubMedGoogle Scholar
  66. 66.
    Torgerson S, Wiebe LA. Supportive care of the patient with advanced pancreatic cancer. Oncology. 2013;27:183–90.PubMedGoogle Scholar
  67. 67.
    Caraceni A, Hanks G, Kaasa S, Bennett MI, Brunelli C, Cherny N, Dale O, De Conno F, Fallon M, Hanna M, Haugen DF, Juhl G, King S, Klepstad P, Laugsand EA, Maltoni M, Mercadante S, Nabal M, Pigni A, Radbruch L, Reid C, Sjogren P, Stone PC, Tassinari D, Zeppetella G. Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC. Lancet Oncol. 2012;13:e58–68.  https://doi.org/10.1016/S1470-2045(12)70040-2.CrossRefPubMedGoogle Scholar
  68. 68.
    Seicean A. Celiac plexus neurolysis in pancreatic cancer: the endoscopic ultrasound approach. World J Gastroenterol. 2014;20:110–7.  https://doi.org/10.3748/wjg.v20.i1.110.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    McGreevy K, Hurley RW, Erdek MA, Aner MM, Li S, Cohen SP. The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: a pilot study. Pain Pract. 2013;13:89–95.  https://doi.org/10.1111/j.1533-2500.2012.00557.x.CrossRefPubMedGoogle Scholar
  70. 70.
    Maire F, Hammel P, Ponsot P, Aubert A, O’Toole D, Hentic O, Levy P, Ruszniewski P. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol. 2006;101:735–42.  https://doi.org/10.1111/j.1572-0241.2006.00559.x.CrossRefPubMedGoogle Scholar
  71. 71.
    Matsuda Y, Shimakura K, Akamatsu T. Factors affecting the patency of stents in malignant biliary obstructive disease: univariate and multivariate analysis. Am J Gastroenterol. 1991;86:843–9.PubMedGoogle Scholar
  72. 72.
    Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;7:18.  https://doi.org/10.1186/1471-230X-7-18.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Fearon KC, Voss AC, Hustead DS. Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006;83:1345–50.CrossRefGoogle Scholar
  74. 74.
    Fearon KC. Cancer cachexia: developing multimodal therapy for a multidimensional problem. Eur J Cancer. 2008;44:1124–32.  https://doi.org/10.1016/j.ejca.2008.02.033.CrossRefPubMedGoogle Scholar
  75. 75.
    Tuca A, Jimenez-Fonseca P, Gascón P. Clinical evaluation and optimal management of cancer cachexia. Crit Rev Oncol Hematol. 2013;88:625–36.  https://doi.org/10.1016/j.critrevonc.2013.07.015.CrossRefPubMedGoogle Scholar
  76. 76.
    Sarr MG, Kendrick ML, Nagorney DM, Thompson GB, Farley DR, Farnell MB. Cystic neoplasms of the pancreas; benign to malignant epithelial neoplasms. Surg Clin North Am. 2001;81:497–509.CrossRefGoogle Scholar
  77. 77.
    Wilentz RE, Albores-Saavedra J, Hruban RH. Mucinous cystic neoplasms of the pancreas. Semin Diagn Pathol. 2000;17:31–42.PubMedGoogle Scholar
  78. 78.
    Tanaka M, Chari S, Adsay V, Fernandez-del Castello C, Falconi M, Shimuzu M, Yamaguchi K, Yamao K, Matsuno S. International consensus guidelines for management of intraductal mucinous neoplasm and mucinous cystic neoplasm of the pancreas. Pancreatology. 2006;6:17–32.CrossRefGoogle Scholar
  79. 79.
    Terris B, Ponsot P, Paye F, Hammel P, Sauvanet A, Molas G, Bernades P, Belghiti J, Ruszniewski P, Flejou JF. Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol. 2000;24:1372–7.CrossRefGoogle Scholar
  80. 80.
    Brozzetti S, Mazzoni G, Miccini M, et al. Surgical treatment of pancreatic head carcinoma in elderly patients. Arch Surg. 2006;141(2):137–42.  https://doi.org/10.1001/archsurg.141.2.137.CrossRefPubMedGoogle Scholar
  81. 81.
    Scurtu R, Bachellier P, Oussoultzoglou E, Rosso E, Maroni R, Jaeck D. Outcome after pancreaticoduodenectomy for cancer in elderly patients. Gastrointest Surg. 2006;10(6):813–22.  https://doi.org/10.1016/j.gassur.2005.12.010.CrossRefGoogle Scholar
  82. 82.
    Oguro S, Shimada K, Kishi Y, et al. Perioperative and longterm outcomes after pancreaticoduodenectomy in elderly patients 80 years of age and older. Langenbeck’s Arch Surg. 2013;398(4):531–8.  https://doi.org/10.1007/s00423-013-1072-7.CrossRefGoogle Scholar
  83. 83.
    Frakes JM, Strom T, Springett GM, et al. Resected pancreatic cancer outcomes in the elderly. J Geriatr Oncol. 2015;6(2):127–32.  https://doi.org/10.1016/j.jgo.2014.11.005.CrossRefPubMedGoogle Scholar
  84. 84.
    Zhang D, Gao J, Li S, et al. Outcome after pancreaticoduodenectomy for malignancy in elderly patients. Hepato-Gastroenterology. 2015;62(138):451–4.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Sergio Alfieri
    • 1
  • Fausto Rosa
    • 1
  • Dario Di Miceli
    • 1
  • Giovanni Battista Doglietto
    • 1
  1. 1.Department of Digestive SurgeryCatholic University, “A. Gemelli” HospitalRomeItaly

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