Pancreatic Surgery in the Very Old: Face to Face With a Challenge of the Near Future

Abstract

Despite high mortality and morbidity rates, surgery remains the only chance for cure in most octogenarians with pancreatic disease. Careful patient selection is the key to success and improved long-term survival in this group, which will represent a substantial fraction of the population in the near future.

Outcome of pancreaticoduodenectomy in octogenarians: Single institution's experience and review of the literature

“…Older patients had also similar lengths of stay compared to younger patients. These results compare favorably with that of other surgical series [8,9,[11][12][13][14][15][16][17][18][19][20][21].…”

“…Overall morbidity and mortality rates were 48.0 and 13.6%, respectively (Table 2), with a length of hospital stay of 16.7 days. If we compare the outcome of patients operated in single centers [8,9,[12][13][14][15][16][17][18][19]21] with high-volume of pancreatic surgery versus those collected in multicentric reports [10,11,20], operative mortality was 3.9% vs. 15%, and length of hospital stay was 14.3 vs. 20.1 days, respectively (Table 2). Longterm survival in octogenarians was not different compared to the survival of younger patients [6,17,18].…”

“…Literature's review: the preliminary literature search showed 111 studies matching the initial search criteria. After screening, 14 studies evaluating 80-year or older age populations were selected [8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 2). A total of 26,234 pancreatic resections (including our series) were collected: of these, 3681 PDs (14%) were performed in octogenarians.…”

“…We examined the English literature, and collected 3681 PDs performed in octogenarians [8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 2). Surprisingly, only two series came from European countries (French and German study, respectively) [20,21] one was a multicentric study [20] Pancreaticoduodenectomy in octogenarians 5 or older collected in 37 institutions.…”

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

“…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].…”