Comparison of Outcomes and the Use of Multimodality Therapy in Young and Elderly People Undergoing Surgical Resection of Pancreatic Cancer

Barbas, Andrew S.; Turley, Ryan S.; Ceppa, Eugene P.; Reddy, Srinevas K.; Blazer, Dan G.; Clary, Bryan M.; Pappas, Theodore N.; Tyler, Douglas S.; White, Rebekah R.; Lagoo, Sandhya A.

doi:10.1111/j.1532-5415.2011.03785.x

Cited by 64 publications

(45 citation statements)

References 41 publications

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“…Outcomes of various surgical procedures, including PD, in the older population, have become a subject of concern; however, limited data exist [4, 7–12, 17]. It has been well established in previous studies that PD could safely be performed for patients aged 70 years or older.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies have reported age to be a risk factor in postoperative morbidity after pancreatic resection [6, 11, 13–16], while others reported that increased age alone does not prohibit pancreatic surgery [7, 10, 12, 17]. Recently, Lee et al reported that increased age is not a risk factor for postoperative mortality based on information from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database [3].…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic Surgery in the Older Population: A Single Institution’s Experience over Two Decades

Brahmbhatt

Bhurwal

Lukens

et al. 2016

Current Gerontology and Geriatrics Research

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Objectives. Surgery is the most effective treatment for pancreatic cancer. However, present literature varies on outcomes of curative pancreatic resection in the elderly. The objective of the study was to evaluate age as an independent risk factor for 90-day mortality and complications after pancreatic resection. Methods. Nine hundred twenty-nine consecutive patients underwent 934 pancreatic resections between March 1995 and July 2014 in a tertiary care center. Primary analyses focused on outcomes in terms of 90-day mortality and postoperative complications after pancreatic resection in these two age groups. Results. Even though patients aged 75 years or older had significantly more postoperative morbidities compared with the younger patient group, the age group was not associated with increased risk of 90-day mortality after pancreatic resection. Discussion. The study suggests that age alone should not preclude patients from undergoing curative pancreatic resection.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pancreatic Surgery in the Older Population: A Single Institution’s Experience over Two Decades

Brahmbhatt

Bhurwal

Lukens

et al. 2016

Current Gerontology and Geriatrics Research

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“…Other institutional studies have been hampered by small sample sizes and wide-ranging criteria of what constitutes an elderly population. 3,[25][26][27][28] In addition, single-center results may not be generalizable to institutions that are not specialized pancreatic surgery centers. In contrast, our analysis contains data from a large, multiple-institution, heterogeneous patient pool (923 PDs done in patients 80 years).…”

Section: Discussionmentioning

confidence: 99%

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

Bergquist¹,

Shubert²,

Ubl³

et al. 2016

HPB

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Background: Expected mortality after elective pancreaticoduodenectomy (PD) in contemporary series is less than 5% in elderly patients; however, to our knowledge, mortality rate has not been correlated with indication for PD. We hypothesized that perioperative risk following PD would correlate with diagnostic indication in older patients. Methods:The American College of Surgeons NSQIP database was reviewed to identify patients (<80 and 80 years) who underwent PD from January 1, 2005, through December 31, 2012. High-and low-risk diagnoses were determined by using 30-day, major-morbidity data. Univariate and multivariable analyses were used to compare outcomes.Results: Pancreatic cancer and chronic pancreatitis were found to be low-risk diagnoses in elderly patients, whereas bile duct and ampullary neoplasm, duodenal neoplasm, and neuroendocrine tumors were high-risk diagnoses. The risk of 30-day mortality for older patients (80 y) undergoing PD was 6.1% for those with high-risk diagnoses vs 4.5% for those with low-risk diagnoses (P = .27). On multivariable analysis (controlling for confounders), a high-risk diagnosis was shown to be an independent predictor of prolonged length of stay, superficial surgical-site infection (SSI), and organ-space SSI. There was no increased risk of complications in patients 80 years with low-risk diagnoses. Conclusion:In patients 80 or older undergoing PD, perioperative risk varies by diagnostic indication.Patients should receive preoperative counseling about their risk.

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“…Although these initially began as classroom interactions, they now commonly extend into the clinical arena, which we believe will have a positive impact in improving the care of elderly surgical patients in our hospital. Moreover, there has been a global increase in resident interest in geriatric surgery research, and several residents have performed clinical outcomes studies in the geriatric population and successfully published their work (Barbas et al, 2012;Reddy et al, 2011;Speicher, Lagoo-Deenadayalan, Galanos, Pappas, & Scarborough, 2013).…”

Section: Discussionmentioning

confidence: 99%

Development and Implementation of a Formalized Geriatric Surgery Curriculum for General Surgery Residents

Barbas

Haney

Henry

et al. 2014

Gerontology & Geriatrics Education

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Despite the growth of the elderly population, most surgical training programs lack formalized geriatric education. The authors' aim was to implement a formalized geriatric surgery curriculum at an academic medical center. Surgery residents were surveyed on attitudes toward the care of elderly patients and the importance of various geriatric topics to daily practice. A curriculum consisting of 16 didactic sessions was created with faculty experts moderating. After curriculum completion, residents were surveyed to assess curriculum impact. Residents expressed increased comfort in accessing community resources. A greater percentage of residents recognized the significance of delirium and acute renal failure in elderly patients. Implementing a geriatric surgery curriculum geared toward surgery residents is feasible and can increase resident comfort with multidisciplinary care and recognition of clinical conditions pertinent to elderly surgical patients. This initiative also provided valuable experience for geriatric surgery curriculum development.

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Comparison of Outcomes and the Use of Multimodality Therapy in Young and Elderly People Undergoing Surgical Resection of Pancreatic Cancer

Abstract: Carefully selected elderly individuals experience similar perioperative outcomes and overall survival to those of younger individuals after resection of pancreatic cancer. There appears to be a significant disparity in the use of adjuvant therapy between young and elderly individuals.

Cited by 64 publications

References 41 publications

Pancreatic Surgery in the Older Population: A Single Institution’s Experience over Two Decades

Pancreatic Surgery in the Older Population: A Single Institution’s Experience over Two Decades

Risk by indication for pancreaticoduodenectomy in patients 80 years and older: a study from the American College of Surgeons National Surgical Quality Improvement Program

Development and Implementation of a Formalized Geriatric Surgery Curriculum for General Surgery Residents

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