Octogenarians undergoing pancreaticoduodenectomy: Assessing outcomes, disposition, and timing of chemotherapy

Abstract

Background Inclusion of pancreaticoduodenectomy has demonstrated higher rates of curative treatment in pancreatic cancer, yet prior research has suggested increased postoperative complications in octogenarians (patients older than 80 years). This study aimed to understand the impact of age on patients undergoing a pancreaticoduodenectomy, focusing on postoperative outcomes and return to intended oncologic treatment. Materials and Methods We conducted a single-institution retrospective cohort study for patients undergoing pancreaticoduodenectomy from 2007 to 2018. Collected data included demographics, preoperative comorbidities, and postoperative data (length of stay, 30-day mortality, 1-year mortality, infection, discharge location). Data were separated into 2 cohorts: octogenarians (≥ 80 years) and nonoctogenarians (< 80). χ 2 and independent-sample t tests were used for analysis. Results A total of 649 patients underwent pancreaticoduodenectomy from 2007 to 2018; 63 (9.7%) were octogenarians. No differences were found in infectious complications (P = .607), 30-day mortality (P = .363), or 1-year mortality (P = .895). Octogenarians had a longer length of stay (P = .003) and were more likely to be discharged to skilled nursing facilities (P < .001). There was no significant difference in neoadjuvant chemotherapy administration, although octogenarians were less likely to receive adjuvant chemotherapy (P = .048) and declined adjuvant therapy at a higher rate (P = .003). Conclusion Performing a pancreaticoduodenectomy in octogenarians can be safe and effective in a properly selected cohort. Although postoperative morbidity and mortality are similar to younger patients, elderly patients are more likely to be discharged to nursing facilities and less likely to receive adjuvant chemotherapy. This study suggests that age alone should not be a discriminating factor when discussing surgical therapy for pancreatic cancer treatment in octogenarians.

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

“…demonstrated that advanced age was associated with significantly worse short‐term outcomes in older patients who underwent gastroenterological surgeries such as esophagectomy, gastrectomy, colectomy, hepatectomy, and PD 29 . Conversely, some previous reports have indicated that the postoperative morbidity and mortality of patients in older patients who underwent PD were equal to those of younger patients 5–15 . However, most of these previous studies had small numbers of patients and were reported from high‐volume centers that provided high‐quality medical care.…”

“…In hospital mortality 29 Conversely, some previous reports have indicated that the postoperative morbidity and mortality of patients in older patients who underwent PD were equal to those of younger patients. [5][6][7][8][9][10][11][12][13][14][15] However, most of these previous studies had small numbers of patients and were reported from high-volume centers that provided high-quality medical care. Therefore, verification with real-world data is necessary to clarify the status of older individuals who undergo PD.…”

“…The relevance of this controversy is highlighted by recent concerns about surgery for older individuals with comorbidities. Although some reports suggest that PD can be performed safely in older individuals, most of these reports are from high‐volume centers, 5–15 and few reports are based on real‐world data.…”

Surgical Risks and Survival Outcomes in Robotic Pancreaticoduodenectomy for the Aged Over 80: A Retrospective Cohort Study

“…While the data used for this study are collected prospectively, the retrospective nature of this study would still introduce selection bias. Moreover, this study only focused on the immediate postoperative period and did not study the extended postoperative period or quality of life, which could have significant impacts on outcomes, as mentioned by Kisch et al 3 In addition, the optimized outcomes presented are a collaborative effort among several surgeons who often work in tandem during the initial learning curve to ensure patient safety. As such, the results might not be generalizable to other smaller centers that are unable to allocate the required resources and infrastructure, as reminded by Zureikat and coworkers at the University of Pittsburgh.…”

“…1 Given the aging population and the associated increased incidence of malignancy with age, pancreatic adenocarcinoma, and periampullary malignancies are increasingly identified in the older brackets of the population. [2][3][4] Pancreaticoduodenectomy, commonly known as the "Whipple procedure", is a complex and challenging procedure and is considered the standard surgical treatment for the lesions in the periampullary region and pancreatic head. In the past, a major operation such as pancreaticoduodenectomy was not considered for older people after being diagnosed with a periampullary lesion.…”