Abstract
Background
Although the mortality rates for pancreaticoduodenectomy have been reported to be low for periampullary tumors at high-volume centers, postoperative results still remain unclear for elderly patients over 80 years of age.
Methods
This was a retrospective study of patients who underwent a pancreaticoduodenectomy and consisted of 335 patients who were treated for periampullary tumors between January 1994 and August 2008. The main outcomes were postoperative complications, mortality, and the length of hospital stay among the elderly patients, and they were analyzed in three groups: elderly patients over 80 years old, septuagenarians, and those under 70 years of age.
Results
The performance status of elderly patients was lower than that of the patients under 70 (P < 0.05), and the elderly had a higher American Society of Anesthesiologists physical status classification score (P < 0.001) as well as low hemoglobin and serum albumin levels (P < 0.01 and P < 0.001, respectively). The incidence of delayed gastric emptying in the elderly was higher; however, there was no significant difference. The other outcomes in the elderly group were similar to those of the other groups.
Conclusions
Pancreaticoduodenectomy was considered to be a feasible surgical procedure for elderly patients who had a good performance status.
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References
Kincannon CL. National bibliography of US government publications. Statistial Abstract of the United States: 2004–2005. Washington: US Census Bureau; 2005.
Ishikawa A, Beppu M, Sato R. Population statistics of Japan 2006. Yamato-sogo. Tokyo, Japan; 2006.
Etzioni D, Liu J, Maggard M, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238:170–7.
Lillemoe KD. Pancreatic and periampullary carcinoma in the elderly. Gastrointestinal surgery in the elderly. Probl Gen Surg. 1996;13:108–20.
Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg. 1997;226:248–57.
Suojaranta-Ylinen RT, Kuitunen AH, Kukkonen SI. Risk evaluation of cardiac surgery in octogenarians. J Cardiothorac Vasc Anesth. 2006;20:526–30.
Vickers SM, Kerby JD, Smoot TM, Shumate CR, Halpern NB, Aldrete JS, et al. Economics of pancreaticoduodenectomy in the elerly. Surgery. 1996;120:620–6.
Dicarlo V, Balzano G, Zebri A, Villa E. Pancreatic cancer resection in elderly patients. Br J Surg. 1998;85:607–10.
Bottger TC, Engelmann R, Junginger T. Is age a risk factor for major pancreatic surgery? An analysis of 300 resections. Hepatogastroenterol. 1999;46:2589–98.
Bathe OF, Levi D, Caldera H, Franceschi D, Raez L, Patel A, et al. Radical resection of periampullary tumors in the elderly: evaluation of long-term results. World J Surg. 2000;24:353–8.
Lightner AM, Glasgow RE, Jordan TH, Krassner AD, Way LW, Mulvihill SJ, et al. Pancreatic resection in the elderly. J Am Coll Surg. 2004;198:697–706.
Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, et al. Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg. 1998;2:207–16.
Finlayson E, Fan Z, Birkmeyer JD. Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg. 2007;205:729–34.
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;248:459–67.
Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg. 2006;10:347–56.
Kondo S, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M. Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment. J Hepatobiliary Pancreat Surg. 2008;15:41–54.
Kawai M, Uchiyama K, Tani M, Onishi H, Kinoshita H, Ueno M, et al. Clinicopathological features of malignant intraductal papillary mucinous tumors of the pancreas: the differential diagnosis from benign entities. Arch Surg. 2004;139:188–92.
Kawarada Y, Isaji S. Modified standard (D1 + a) pancreaticoduodenectomy for pancreatic cancer. J Gastrointest Surg. 2000;4:227–8.
Tani M, Onishi H, Kinoshita H, Kawai M, Ueno M, Hama T, et al. The evaluation of duct-to-mucosal pancreaticojejunostomy in pancreaticoduodenectomy. World J Surg. 2005;29:76–9.
Tani M, Terasawa H, Kawai M, Ina S, Hirono S, Uchiyama K, et al. Improvement of delayed gastric emptying in pylorus-preserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial. Ann Surg. 2006;243:316–20.
Tani M, Kawai M, Terasawa H, Ueno M, Hama T, Hirono S, et al. Complications with reconstruction procedures in pylorus-preserving pancreaticoduodenectomy. World J Surg. 2005;29:881–4.
Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg. 2006;244:1–7.
Büchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’graggen K. Pancreatic fistula after pancreatic head resection. Br J Surg. 2000;87:883–9.
Neoptolemos JP, Russell RCG, Bramhall S, Theis B. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. Br J Surg. 1997;84:1370–6.
Okabayashi T, Kobayashi M, Nishimori I, Sugimoto T, Onishi S, Hanazaki K. Risk factors, predictors and prevention of pancreatic fistula formation after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg. 2007;14:557–63.
Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the pancreatic anastomotic leak study group. J Hepatobiliary Pancreat Surg. 2007;11:1451–9.
Detsky AS, Baker JP, O’Rourke K, Johnston N, Whitwell J, Mendelson RA, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. J Parenter Enteral Nutr. 1987;11:440–6.
Covinsky K, Martin G, Beyth RJ. The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized patients. J Am Geriatr Soc. 1999;47:532–8.
Ament R. The expanding role of the American Society of Anesthesiologists. Anesthesiology. 1976;45:475–6.
Audisio R, Ramesh H, Longo W, Zbar A, Pope D. Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist. 2005;10:262–8.
Yamaguchi K, Tanaka M, Chijiiwa K, Nagakawa T, Imamura M, Takada T. Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepatobiliary Pancreat Surg. 1999;6:303–11.
Scurtu R, Bachellier P, Oussoultzoglow E, Rosso E, Maroni R, Jaeck D. Outcome after pancreaticoduodenectomy for cancer in elderly patients. J Gastrointest Surg. 2006;10:813–22.
Brennan MF, Kattan MW, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240:293–8.
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Tani, M., Kawai, M., Hirono, S. et al. 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 (2009). https://doi.org/10.1007/s00534-009-0106-6
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DOI: https://doi.org/10.1007/s00534-009-0106-6