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.
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.
Authors: O Turrini; F Paye; P Bachellier; A Sauvanet; A Sa Cunha; Y P Le Treut; M Adham; J Y Mabrut; L Chiche; J R Delpero Journal: Eur J Surg Oncol Date: 2012-09-19 Impact factor: 4.424
Authors: Thomas Zacharias; Daniel Jaeck; Elie Oussoultzoglou; Philippe Bachellier; Jean-Christophe Weber Journal: Ann Surg Date: 2004-11 Impact factor: 12.969
Authors: Minna K Lee; Joseph Dinorcia; Patrick L Reavey; Marc M Holden; Jeanine M Genkinger; James A Lee; Beth A Schrope; John A Chabot; John D Allendorf Journal: J Gastrointest Surg Date: 2010-09-08 Impact factor: 3.452
Authors: Taylor S Riall; John L Cameron; Keith D Lillemoe; Jordan M Winter; Kurtis A Campbell; Ralph H Hruban; David Chang; Charles J Yeo Journal: Surgery Date: 2006-08-28 Impact factor: 3.982
Authors: Krishna V Menon; Ahmed Al-Mukhtar; Amer Aldouri; Rajendra K Prasad; Peter A Lodge; Giles J Toogood Journal: J Am Coll Surg Date: 2006-09-26 Impact factor: 6.113
Authors: J Ferlay; E Steliarova-Foucher; J Lortet-Tieulent; S Rosso; J W W Coebergh; H Comber; D Forman; F Bray Journal: Eur J Cancer Date: 2013-02-26 Impact factor: 9.162
Authors: Guy Lahat; Ronen Sever; Nir Lubezky; Ido Nachmany; Fabian Gerstenhaber; Menahem Ben-Haim; Richard Nakache; Josef Koriansky; Josef M Klausner Journal: World J Surg Oncol Date: 2011-01-27 Impact factor: 2.754
Authors: Trientje B Santema; Annelies Visser; Olivier R C Busch; Marcel G W Dijkgraaf; J Carel Goslings; D J Gouma; Dirk T Ubbink Journal: HPB (Oxford) Date: 2015-06-17 Impact factor: 3.647
Authors: Maikel J Bakens; Lydia G van der Geest; Magreet van Putten; Hanneke W van Laarhoven; Geert-Jan Creemers; Marc G Besselink; Valery E Lemmens; Ignace H de Hingh Journal: Cancer Med Date: 2016-09-27 Impact factor: 4.452