Is the chronologic age a contra‐indication for surgical palliation of unresectable periampullary neoplasms?

Nuzzo, Gennaro; Clemente, Gennaro; Greco, Francesco; Ionta, Raffaele; Cadeddu, Federica

doi:10.1002/jso.20147

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Nuzzo et al [12] reported that the morbidity and mortality rates for surgical palliation in elderly patients (> 70 years) with periampullary cancer were comparable to those of younger patients (≤ 70 years), with no statistically significant difference found between the 2 groups. In our study, postoperative morbidity and mortality rates in elderly patients were 26% (5 patients) and 5.3% (one patient), respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Even if most patients with pancreatic head cancer are not candidates for radical surgical resection, because of early metastatic spread or extensive local tumor involvement, palliation of obstructive symptoms and pain remains a core component in the management of this disease. Di Carlo et al [11] reported there was no significant difference in the frequency of locally advanced or metastatic disease www.wjgnet.com [12,13] . Although endoscopic stenting of the bile duct or PTBD can relieve biliary obstruction, surgical bypass is done in many cases because of patient or physician preference, an inability to access the bile duct, or failure of non-surgical palliation [14] .…”

Section: Discussionmentioning

confidence: 99%

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Surgical palliation of unresectable pancreatic head cancer in elderly patients

Hwang¹,

Kim²,

Son³

et al. 2009

WJG

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AIM:To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS:Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS:Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively).The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION:Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical palliation of unresectable pancreatic head cancer in elderly patients

Hwang¹,

Kim²,

Son³

et al. 2009

WJG

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“…7,8 Palliative chemotherapy and bypass surgery have been shown to be beneficial in improving the quality of life of selected patients with incurable disease. 13 The present study uses a prospective population-based registry to capture patients at the time of diagnosis and consequently follow the management of their PA.…”

Section: Discussionmentioning

confidence: 99%

Management of pancreatic adenocarcinoma in Ontario, Canada: a population-based study using novel case ascertainment

Borgida

2011

Can J Surg

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Background: Pancreatic adenocarcinoma (PA) is largely incurable, although recent progress has been made in the safety of surgery for PA and in adjuvant and palliative chemotherapy. The purpose of this study was to describe the management of PA in Ontario, Canada. Methods:The Pathology Information Management System (PIMS), which uses electronic pathology reporting (E-path), was used to rapidly identify and recruit patients based on a pathologic diagnosis of PA between 2003 and 2006. Patients were mailed questionnaires for additional data. Results:The patient participation rate was 26% (351 of 1325). Nonresponders were more likely to be older than 70 years (43% v. 28%, p < 0.001) and to have received treatment in nonacademic centres (53% v. 34%, p < 0.001). Fifty-four percent of responders underwent a potentially curative operation, and most (77%) were 70 years or younger (p = 0.03). Completed resections were documented in 83% of patients who underwent exploratory surgery with curative intent; 17% of patients had unresectable and/or metastatic disease at laparotomy. Of the completed resections, 24% were performed in nonacademic centres with a 32% positive margin rate; 76% were performed in academic centres with a 29% positive margin rate (p = 0.84). Resections with curative intent were less frequently aborted in academic centres (10% v. 33%, p < 0.001). Of the patients who responded to our questionnaire, 43% received chemotherapy and 7% participated in clinical trials. Conclusion:Despite using PIMS and E-path, the response rate for this study was low (< 30%). Nonresponders were older and more commonly treated in nonacademic centres. Patients undergoing surgery in academic centres had higher resection rates. The rate of adjuvant and palliative chemotherapy was stage-dependent and low.Contexte : L'adénocarcinome du pancréas (AP) est en grande partie incurable, même si on a réalisé récemment des progrès au niveau de la sécurité de l'intervention chirurgicale contre l'AP et au niveau de la chimiothérapie d'appoint et palliative. Cette étude visait à décrire la prise en charge de l'AP en Ontario, au Canada. Résultats : Le taux de participation des patients a atteint 26 % (351 sur 1325). Les non-répondants étaient plus susceptibles d'avoir plus de 70 ans (43 % c. 28 %, p < 0,001) et d'avoir été traités dans des centres non universitaires (53 % c. 34 %, p < 0,001). Cinquante-quatre pour cent des répondants ont subi une intervention curative et la plupart (77 %) avaient 70 ans ou moins (p = 0,03). Les résections complétées ont été documentées chez 83 % des patients qui ont subi une intervention chirurgicale exploratoire à but curatif; 17 % des patients avaient une maladie irréséca-ble ou à métastases au moment de la laparotomie. Sur le total des résections complétées, 24 % ont été pratiquées dans des centres non universitaires et il y avait marge positive dans 32 % des cas, et 76 % ont été effectuées dans les centres universitaires et il y avait marge positive dans 29 % des cas (p = 0,84). Les résections à but curatif ont...

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