Outcomes of pancreaticoduodenectomy for pancreatic malignancy in octogenarians: an American College of Surgeons National Surgical Quality Improvement Program analysis

Lee, David Y.; Schwartz, Jamie A.; Wexelman, Barbara; Kirchoff, Daniel D.; Yang, Kevin; Attiyeh, Fadi F.

doi:10.1016/j.amjsurg.2013.07.042

Cited by 53 publications

(68 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thirty-day postoperative mortality in octogenarians (7.7%) in our study was in line with previous population-based and multi-institutional studies showing a (30-day and/or in-hospital) postoperative mortality between 4.7% and 15.5% [3,4,10]. In concordance with a large observational study of patients undergoing pancreatoduodenectomy for cancer [12], short-term mortality risk of octogenarians in our study did not differ from that of other elderly age groups. In addition, our study showed that also long-term survival of octogenarians was similar to that of other elderly patient groups.…”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, no information was available on postoperative complications and cause of death. Overall, mixed results were found on the association of high age and morbidity after pancreatic surgery for cancer [2,5,8,12]. However, in studies that differentiated between surgical and non-surgical complications, age differences were particularly found in non-surgical complications [12,25].…”

Section: Discussionmentioning

confidence: 99%

“…With improving postoperative mortality risk, more elderly patients, including fit octogenarians, may be offered pancreatic surgery [4]. Although several specialised institutions reported an absence of an impact of very old age on postoperative mortality [5][6][7][8], some population-based studies on this topic showed unfavourable postoperative outcomes in octogenarians compared to younger patients [4,[9][10][11][12]. However, less is known about octogenarians compared to other elderly age groups.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

et al. 2015

View full text Add to dashboard Cite

Background: At a national level, it is unknown to what degree elderly patients with pancreatic or periampullary carcinoma benefit from surgical treatment compared to their younger counterparts. We investigated resection rates and outcomes after surgical treatment among elderly patients. Methods: From the Netherlands Cancer Registry, 20 005 patients diagnosed with primary pancreatic or periampullary cancer in 2005-2013 were selected. The associations between age (570, 70-74, 75-79, 80 years) and resection rates were investigated using 2 tests, and surgical outcomes (30-, 90-day mortality) were evaluated using logistic regression analysis. Overall survival after resection was investigated by means of Kaplan-Meier and Cox proportional hazard regression analysis. Results: During the study period, resection rates increased in all age groups (570 years: 20-30%, p50.001; 80 years: 2-8%, p50.001). Of 3845 patients who underwent tumour resection for pancreatic or periampullary carcinoma, the proportion of octogenarians increased from 3.5% to 5.5% (p ¼ 0.03), whereas postoperative mortality did not increase (30-day: 6-3%, p ¼ 0.06; 90-day: 9-8%, p ¼ 0.21). With rising age, 30-day postoperative mortality increased (4-5-7-8%, respectively, p50.001), while 90-day mortality was 6-10-13-12% (p50.001) and three-year overall survival rates after surgery were 35-33-28-31%, respectively (p50.001). After adjustment for confounding factors, octogenarians who survived 90 days postoperative exhibited an overall survival close to younger patients [hazard ratio (80 vs.570 years) ¼ 1.21, 95% confidence interval (0.99-1.47), p ¼ 0.07]. Conclusion: Despite higher short-term mortality, octogenarians who underwent pancreatic resection showed long-term survival similar to younger patients. With careful patient screening and counselling of elderly patients, a further increase of resection rates may be combined with improved outcomes.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

et al. 2015

View full text Add to dashboard Cite

show abstract

“…As discussed, the type of pathology affects the expected complication rate so that patients with pancreatic cancer and chronic pancreatitis are less likely to experience postoperative leaks than patients with duodenal, neuroendocrine, or biliary tract tumors. 30 The study by Lee et al 2 shows an increased mortality rate from 2% (patients <80 years) compared with 6% (patients 80 years), which is supported by our data for patients with a low-risk diagnosis. In the current study, rates of organ-space infection and prolonged LOS were higher in the high-risk population of patients at least 80 years of age.…”

Section: Discussionsupporting

confidence: 88%

“…Advances in the postoperative care of patients undergoing PD have resulted in improved postoperative mortality rates-less than 5% for elective PD, even in older patients (80 years). [1][2][3] However, the rate of perioperative morbidity remains high. [4][5][6][7][8][9] Therefore, preoperative risk stratification is an important component of patient counseling.…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

A comparative analysis of survival outcomes between pancreatectomy and chemotherapy for elderly patients with adenocarcinoma of the pancreas

Marmor

Burke

Virnig

et al. 2016

Cancer

View full text Add to dashboard Cite

The survival benefit associated with surgical resection compared with chemotherapy was very small for certain subgroups of patients (those aged ≥80 years and those with lymph node metastases). The results of the current study indicate that although surgery is associated with a survival benefit in the elderly, chemotherapy should be considered as a legitimate therapeutic alternative. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:3378-3385. © 2016 American Cancer Society.

show abstract

Outcomes of pancreaticoduodenectomy for pancreatic malignancy in octogenarians: an American College of Surgeons National Surgical Quality Improvement Program analysis

Cited by 53 publications

References 30 publications

Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

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

A comparative analysis of survival outcomes between pancreatectomy and chemotherapy for elderly patients with adenocarcinoma of the pancreas

Contact Info

Product

Resources

About