Takehiro Okabayashi1, Kenta Sui1, Takahiro Murokawa1, Jiro Kimura1, Jun Iwata2, Sojiro Morita3, Tatsuo Iiyama4, Yasuhiro Shimada5. 1. Department of Gastroenterological Surgery Kochi Health Sciences Center Kochi Japan. 2. Department of Diagnostic Pathology Kochi Health Sciences Center Kochi Japan. 3. Department of Radiology Kochi Health Sciences Center Kochi Japan. 4. Department of Biostatistics National Center for Global Health and Medicine Shinjuku-ku Japan. 5. Department of Clinical Oncology Kochi Health Sciences Center Kochi Japan.
Abstract
AIMS: The safety and efficacy of pancreaticoduodenectomy (PD) in patients over the age of 80 years remain controversial. We aimed to examine post-PD outcomes and to determine the age limit for PD. METHODS: Patients were divided into two subgroups: the younger (<80 years) group and octogenarian (≥80 years) group. We retrospectively evaluated the clinical benefit of PD for periampullary diseases in the younger and octogenarian groups, focusing on short- and long-term outcomes. RESULTS: From March 2005 to December 2018, 586 consecutive surgically curable patients with diagnosed periampullary diseases were studied, among whom 122 (20.8%) were ≥80 years old. The general preoperative physical condition (G8 screening, instrumental activities of daily living, and Charlson comorbidity index) and nutritional status were significantly worse in the octogenarian group. However, there were no significant differences between the younger and octogenarian groups in postoperative severe complication rates (34% vs 36%) or perioperative mortality rates (1.5% vs 0.0%). We observed significantly poorer 3-, 5-, and 10-year overall survivals in the octogenarian group than in the younger group (P = .007). In the younger group, the main cause of death (89.6%) was cancer recurrence. However, only 60% of patients in the octogenarian group developed and died from cancer recurrence. Increased neutrophilic/lymphocyte ratio and elevated Controlling Nutritional Status score were associated with worse outcomes. CONCLUSIONS: It is important to carefully determine the indication for PD in octogenarian patients with periampullary diseases, although patient age over 80 years should not be a contraindication for PD.
AIMS: The safety and efficacy of pancreaticoduodenectomy (PD) in patients over the age of 80 years remain controversial. We aimed to examine post-PD outcomes and to determine the age limit for PD. METHODS: Patients were divided into two subgroups: the younger (<80 years) group and octogenarian (≥80 years) group. We retrospectively evaluated the clinical benefit of PD for periampullary diseases in the younger and octogenarian groups, focusing on short- and long-term outcomes. RESULTS: From March 2005 to December 2018, 586 consecutive surgically curable patients with diagnosed periampullary diseases were studied, among whom 122 (20.8%) were ≥80 years old. The general preoperative physical condition (G8 screening, instrumental activities of daily living, and Charlson comorbidity index) and nutritional status were significantly worse in the octogenarian group. However, there were no significant differences between the younger and octogenarian groups in postoperative severe complication rates (34% vs 36%) or perioperative mortality rates (1.5% vs 0.0%). We observed significantly poorer 3-, 5-, and 10-year overall survivals in the octogenarian group than in the younger group (P = .007). In the younger group, the main cause of death (89.6%) was cancer recurrence. However, only 60% of patients in the octogenarian group developed and died from cancer recurrence. Increased neutrophilic/lymphocyte ratio and elevated Controlling Nutritional Status score were associated with worse outcomes. CONCLUSIONS: It is important to carefully determine the indication for PD in octogenarian patients with periampullary diseases, although patient age over 80 years should not be a contraindication for PD.
Authors: Claudio Bassi; Giovanni Marchegiani; Christos Dervenis; Micheal Sarr; Mohammad Abu Hilal; Mustapha Adham; Peter Allen; Roland Andersson; Horacio J Asbun; Marc G Besselink; Kevin Conlon; Marco Del Chiaro; Massimo Falconi; Laureano Fernandez-Cruz; Carlos Fernandez-Del Castillo; Abe Fingerhut; Helmut Friess; Dirk J Gouma; Thilo Hackert; Jakob Izbicki; Keith D Lillemoe; John P Neoptolemos; Attila Olah; Richard Schulick; Shailesh V Shrikhande; Tadahiro Takada; Kyoichi Takaori; William Traverso; Charles R Vollmer; Christopher L Wolfgang; Charles J Yeo; Roberto Salvia; Marcus Buchler Journal: Surgery Date: 2016-12-28 Impact factor: 3.982
Authors: José Ignacio de Ulíbarri Pérez; Guillermo Fernández; Francisco Rodríguez Salvanés; Ana María Díaz López Journal: Nutr Hosp Date: 2014-01-13 Impact factor: 1.057
Authors: Ibrahim Nassour; Sam C Wang; Alana Christie; Mathew M Augustine; Matthew R Porembka; Adam C Yopp; Michael A Choti; John C Mansour; Xian-Jin Xie; Patricio M Polanco; Rebecca M Minter Journal: Ann Surg Date: 2018-07 Impact factor: 12.969
Authors: Dominic E Sanford; Angela M Sanford; Ryan C Fields; William G Hawkins; Steven M Strasberg; David C Linehan Journal: J Am Coll Surg Date: 2014-06-30 Impact factor: 6.113
Authors: Russell C Langan; Chaoyi Zheng; Katherine Harris; Richard Verstraete; Waddah B Al-Refaie; Lynt B Johnson Journal: Surgery Date: 2015-05-23 Impact factor: 3.982