Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely?

Pineño-Flores, Cristina; Ambrona-Zafra, David; Rodríguez-Pino, José Carlos; Soldevila-Verdeguer, Carla; Palma‐Zamora, Elías; Molina‐Romero, Francesc Xavier; Canis, José Miguel Morón; González‐Argente, Francesc Xavier; Morales-Soriano, Rafael

doi:10.1016/j.cireng.2022.02.011

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…In our study, the results of multilevel logistic regression analysis of the associations between postoperative outcomes and age group showed that the rates of postoperative morbidity and mortality increased with increasing age despite recent advances in perioperative management. Some recent studies in PD in older individuals have reported that patients with older age have a high risk of postoperative mortality and postoperative complications 22–28 . In a recent study that used data from the National Clinical Database in Japan, Omichi et al.…”

Section: Discussionmentioning

confidence: 99%

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Short‐term outcomes of pancreatoduodenectomy in older individuals over a 9‐year period using real‐world data: A multilevel analysis based on a nationwide administrative database in Japan

Mori,

Okawara,

Shibao

et al. 2023

J Hepato Biliary Pancreat

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BackgroundWe aimed to evaluate the short‐term outcomes of pancreatoduodenectomy (PD) in older individuals.MethodsData from the Japanese Diagnosis Procedure Combination database on 62 275 patients who underwent PD from 1 April 2012 to 31 March 2020 were analyzed. Patients were divided into five age groups: <70, 70–74, 75–79, 80–84, and ≥85 years. The associations between postoperative outcomes and age were investigated using multilevel analysis. The mean differences in length of hospital stay and cost were also compared.ResultsThe rate of PD in older individuals increased annually. Compared with the youngest age group (< 70 years), the incidence rate ratios for in‐hospital mortality were 1.52 (95% confidence interval [CI]: 1.30–1.76), 2.07 (1.82–2.37), 2.29 (1.94–2.71), and 2.92 (2.20–3.87) in the 70–74, 75–79, 80–84, and ≥ 85‐year‐old age groups, respectively (all p < .001). Postoperative complications, length of postoperative hospital stay, and cost increased significantly with increasing age.ConclusionsThese real‐world data emphasize the higher levels of morbidity, mortality, and cost in older patients. Careful attention should be paid when considering the indication for PD in older individuals.

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Section: Discussionmentioning

confidence: 99%

“…Some recent studies in PD in older individuals have reported that patients with older age have a high risk of postoperative mortality and postoperative complications. [22][23][24][25][26][27][28] In a recent study that used data from the National Clinical Database in Incidence rate ratio…”

Section: Variablesmentioning

confidence: 99%

Short‐term outcomes of pancreatoduodenectomy in older individuals over a 9‐year period using real‐world data: A multilevel analysis based on a nationwide administrative database in Japan

Mori,

Okawara,

Shibao

et al. 2023

J Hepato Biliary Pancreat

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“…That refers especially to the tumor mobility of the posterior vascular plane and the absence of local and distant metastases. Several statistics over the years have questioned the utility versus the risks of this operation in the elderly [7,8,9,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…A very recent study [11] reported that postoperative infections, especially pneumonia, are more frequently complications after surgery in elderly people. Our case was not developing any infection, most probably due to the long course of antibiotic therapy that covered a wide spectrum of both aerobic and anaerobic pathogens.…”

Section: Discussionmentioning

confidence: 99%

Cephalic Pancreatoduodenectomy (CPD) Performed for Pancreatic Head Adenocarcinoma in a 72 Year- Old Patient - Case Presentation

Габриэль

Crauciuc

Nedelcu

et al. 2021

2021 International Conference on E-Health and Bioengineering (EHB)

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We are presenting a case of mechanical jaundice caused by a pancreatic head cancer in a 72-year-old patient. The clinical examination suspected this diagnosis based on the characteristics of jaundice and the Courvoisier-Terrier sign that was present in the clinical exam. Laboratory and imagistic exams confirm this suspicion. After a short preoperative preparation, a cephalic pancreatoduodenectomy was made using the Whipple procedure. The postoperative evolution was complicated by the appearance of a biliary fistula, which closed after the resuming of intestinal transit. The patient left the surgery department after 25 days of hospitalization. Technological advancement, adequate preoperative rebalancing and especially the emergence of surgical centers specialized in pancreatic resections, have reduced mortality after CPD below 5%. However, an unresolved issue is the long-term survival after CPD for pancreatic cancer (0 -24%), which is considered by some authors disappointing.

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“…Multimodality therapy that includes surgery offers the only prospect of a cure for PC. Surgery is highly invasive and associated with a mortality rate of 3–7% [ 6 , 7 , 8 ]. The recovery time is long and complex, resulting in increased morbidity and a significant monetary burden on the patient and the medical system [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Analytical Validation of Loss of Heterozygosity and Mutation Detection in Pancreatic Fine-Needle Aspirates by Capillary Electrophoresis and Sanger Sequencing

Timmaraju,

Finkelstein,

Levine

2024

Diagnostics

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Pancreatic cystic disease, including duct dilation, represents precursor states towards the development of pancreatic cancer, a form of malignancy with relatively low incidence but high mortality. While most of these cysts (>85%) are benign, the remainder can progress over time, leading to malignant transformation, invasion, and metastasis. Cytologic diagnosis is challenging, limited by the paucity or complete absence of cells representative of cystic lesions and fibrosis. Molecular analysis of fluids collected from endoscopic-guided fine-needle aspiration of pancreatic cysts and dilated duct lesions can be used to evaluate the risk of progression to malignancy. The basis for the enhanced diagnostic utility of molecular approaches is the ability to interrogate cell-free nucleic acid of the cyst/duct and/or extracellular fluid. The allelic imbalances at tumor suppressor loci and the selective oncogenic drivers are used clinically to help differentiate benign stable pancreatic cysts from those progressing toward high-grade dysplasia. Methods are discussed and used to determine the efficacy for diagnostic implementation. Here, we report the analytical validation of methods to detect causally associated molecular changes integral to the pathogenesis of pancreatic cancer from pancreatic cyst fluids.

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Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely?

Cited by 3 publications

References 24 publications

Short‐term outcomes of pancreatoduodenectomy in older individuals over a 9‐year period using real‐world data: A multilevel analysis based on a nationwide administrative database in Japan

Short‐term outcomes of pancreatoduodenectomy in older individuals over a 9‐year period using real‐world data: A multilevel analysis based on a nationwide administrative database in Japan

Cephalic Pancreatoduodenectomy (CPD) Performed for Pancreatic Head Adenocarcinoma in a 72 Year- Old Patient - Case Presentation

Analytical Validation of Loss of Heterozygosity and Mutation Detection in Pancreatic Fine-Needle Aspirates by Capillary Electrophoresis and Sanger Sequencing

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