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

Brahmbhatt, Bhaumik; Bhurwal, Abhishek; Lukens, Frank; Buchanan, Mauricia; Stauffer, John; Asbun, Horacio J.

doi:10.1155/2016/8052175

Cited by 9 publications

(5 citation statements)

References 25 publications

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“…The results of this retrospective study agreed with other similar studies [7,9,10,11,12,13,14,15], including a study by van der Geest et al of 3845 patients from the Netherlands Cancer Registry who underwent resection for primary pancreatic or periampullary carcinoma. Here, they found that octogenarians had greater 30 day and 90 day postoperative mortality compared to younger patients, with an odds ratio (OR) of 2.26 (1.25–4.06) for 30 day mortality and an OR of 2.48 (1.53–4.02) for 90 day mortality compared with patients age ≤70.…”

Section: Localized Diseasesupporting

confidence: 91%

The Management of Older Adults with Pancreatic Adenocarcinoma

et al. 2018

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Pancreatic cancer is the eleventh most common cancer, yet it is the third leading cause of mortality. It is also largely a disease of older adults, with the median age of 71 at diagnosis in the US, with <1% of diagnoses occurring prior to age 50. Current NCCN guidelines recommend surgery for localized disease, followed by adjuvant therapy and/or consideration of enrollment in a clinical trial. For metastatic disease, current guidelines recommend clinical trial enrollment or systemic chemotherapy based on results from the landmark ACCORD-11 and MPACT trials. However, these trials focused heavily on younger, more fit patients, with the ACCORD-11 trial excluding patients over age 75 and the MPACT trial having 92% of its patients with a Karnofsky performance score >80. This article summarizes the available evidence in current literature in regards to the best treatment options for older adults, who represent the majority of pancreatic cancer diagnoses.

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Section: Localized Diseasesupporting

confidence: 91%

The Management of Older Adults with Pancreatic Adenocarcinoma

et al. 2018

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“…In 2012, a meta-analysis reported that elderly patients experience higher rates of postoperative complications and mortality [6]. Other manuscripts, afterward, found that pancreatic surgery has similar safety and efficacy profiles in elderly versus non-elderly [7][8][9][10]. Regarding minimally invasive pancreaticoduodenectomy, data analysis on 1768 elderly patients submitted to laparoscopic versus open pancreaticoduodenectomy from the United States National Cancer Dabatase showed that minimally invasive cases experience lower mortality rates [11].…”

Section: Introductionmentioning

confidence: 99%

Modified Frailty Index to Assess Risk in Elderly Patients Undergoing Distal Pancreatectomy: A Retrospective Single‐Center Study

et al. 2022

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Background To compare the postoperative course of elderly patients (≥70 years) submitted to minimally invasive (MIDP) versus open distal pancreatectomy (ODP) and to evaluate if the modified Frailty Index (mFI) predicts the surgical course of elderly patients submitted to DP. Methods Data of patients aged ≥70 who underwent DP at a single institution between March 2011 and December 2019 were retrospectively retrieved. A 2:1 propensity score matching (PSM) was used to correct for differences in baseline characteristics. Then, postoperative complications were compared between the two groups (MIDP vs. ODP). Additionally, the entire cohort of DP elderly patients was stratified according to the mFI into three groups: non-frail (mFI = 0), mildly frail (mFI = 1/2), or severely frail (mFI = 3) and then compared. Results A total of 204 patients were analyzed. After PSM, 40 MIDP and 80 ODP patients were identified. The complications considered stratified homogenously between the two groups, with no statistically significant differences. The severity of the postoperative course increased as mFI did among the three groups regarding any complication (p = 0.022), abdominal collection (p = 0.014), pulmonary complication (p = 0.001), postoperative confusion (p = 0.047), Clavien-Dindo severity ≥3 events (p = 0.036), and length of stay (p = 0.018). Conclusions Elderly patients can be safely submitted to MIDP. The mFI identifies frail elderly patients more prone to develop surgical and non-surgical complications after DP.

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“…However, compared with the young, the postoperative complications and mortality of the elderly have significantly increased ( 26 , 27 ). Elderly patients were more likely to develop POPF and Clavien-Dindo Score ≥3b than younger ones, probably as a result of the poor recovery of pancreaticojejunostomy, frailty, and the decrease of physical tolerance in the elderly ( 28 – 30 ). Our research further supports the above view.…”

Section: Discussionmentioning

confidence: 99%

Impact of age on short-term outcomes after pancreaticoduodenectomy: A retrospective case-control study of 260 patients

et al. 2023

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BackgroundAlthough the increase of perioperative complications in the elderly undergoing pancreaticoduodenectomy (PD) surgery has been recognized, the definition of the “old patient” of PD in the studies is different and there is no accepted cut-off value at present.Methods279 consecutive patients who have undergone PD in our center between January 2012 and May 2020 were analyzed. Demographic features, clinical-pathological data and short-term outcomes were collected. The patients were divided into two groups, and the cut-off value (62.5 years) is picked based on the highest Youden Index. Primary endpoints were perioperative morbidity and mortality, and complications were classified according to the Clavien-Dindo Score.ResultsA total of 260 patients with PD were included in this study. Postoperative pathology confirmed pancreatic tumors in 62 patients, bile duct tumor in 105, duodenal tumor in 90, and others in 3. Age (OR = 1.09, P < 0.01), and albumin (OR = 0.34, P < 0.05) were significantly correlated with postoperative Clavien-Dindo Score ≥3b. There were 173 (66.5%) patients in the younger group (<62.5 years) and 87 (33.5%) in the elderly group (≥62.5 years). Significant difference between two groups was demonstrated for Clavien-Dindo Score ≥3b (P < 0.01), postoperative pancreatic fistula (P < 0.05), and perioperative deceases (P < 0.05).ConclusionsAge and albumin were significantly correlated with postoperative Clavien-Dindo Score ≥3b, and there was no significant difference in predicting the grade of Clavien-Dindo Score. The cut-off value of elderly patients with PD was 62.5 years old and there were useful in predicting Clavien-Dindo Score ≥3b, pancreatic fistula, and perioperative death.

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

Cited by 9 publications

References 25 publications

The Management of Older Adults with Pancreatic Adenocarcinoma

The Management of Older Adults with Pancreatic Adenocarcinoma

Modified Frailty Index to Assess Risk in Elderly Patients Undergoing Distal Pancreatectomy: A Retrospective Single‐Center Study

Impact of age on short-term outcomes after pancreaticoduodenectomy: A retrospective case-control study of 260 patients

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