Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head is justified in elderly patients: A Retrospective Cohort Study

Renz, Bernhard W.; Khalil, Philipe N.; Mikhailov, Michael; Graf, Sandra; Schiergens, Tobias S.; Nieß, Hanno; Boeck, Stefan; Heinemann, Volker; Hartwig, Werner; Werner, Jens; Bruns, Christiane; Kleespies, Axel

doi:10.1016/j.ijsu.2016.02.064

Cited by 47 publications

(40 citation statements)

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“…According to literature data [ 20 , 31 – 33 ], LA is indicated in patients affected by PCC up to 8 cm, incidentalomas up to 6 cm and metastases <6 cm. Thanks to the use of ultrasound or radiofrequency dissection, we also demonstrated that minimal invasive approach can be safely performed by experienced surgeons also in the treatment of benign tumors larger than 6 cm and in case of metastases, extending the previous surgical indications [ 5 , 6 , 34 , 35 ]. Regarding devices efficacy, in our series we did not observe significant differences between Harmonic scalpel™ (Ethicon Endo Surgery INC - Johnson & Johnson, NJ, USA) and LigaSure ™ vessel sealing system (Tyco, Boulder CO, USA), nevertheless we are more experienced with LigaSure ™.…”

Section: Discussionsupporting

confidence: 53%

“…Also robotic adrenalectomy and posterior retroperitoneal adrenalectomy (PRA) [ 4 ] represent excellent minimal invasive options, especially for benign and medium sized (<6 cm) tumors. Low morbidity rate, short hospitalization, improved cosmesis and a rapid recovery in addition to increasing patients satisfaction and comfort are the main well known advantages [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Single center experience with laparoscopic adrenalectomy on a large clinical series

et al. 2018

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BackgroundLaparoscopic adrenalectomy is considered the gold standard technique for the treatment of benign small and medium size adrenal masses (<6 cm), due to low morbidity rate, short hospitalization and patient rapid recovery. The aim of our study is to analyse the feasibility and efficiency of this surgical approach in a broad spectrum of adrenal gland pathologies.MethodsPre-operative, intra-operative and post-operative data from 126 patients undergone laparoscopic adrenalectomy between January 2003 and December 2015 were retrospectively collected and reviewed. Diagnosis was obtained on the basis of clinical examination, laboratory values and imaging techniques. Doxazosin was preoperatively administered in case of pheochromocytoma while spironolactone and potassium were employed to treat Conn’s disease. Laparoscopic adrenalectomies were all performed by the same surgeon (CG). First 30 procedures were considered as learning curve adrenalectomies.ResultsOne hundred twenty-six patients were included in the study. Functioning tumors were diagnosed in 84 patients, 27 patients were affected by pheochromocytomas, 29 by Conn’s disease, 28 by Cushing disease. Surgery mean operative time was 137.33 min (range 100–180) during the learning curve adrenalectomies and 96.5 min (range 75–110) in subsequent procedures. Mean blood loss was respectively 160.2 ml (range 60–280) and 90.5 ml (range 50–200) in the first 30 procedures and the subsequent ones. Only one conversion to open surgery occurred. No post-operative major complications were observed, while minor complications occurred in 8 patients (0,79%). In 83 out of 84 functioning neoplasms, laparoscopic adrenalectomy was effective in normalization of endocrine profile.ConclusionsLaparoscopic adrenalectomy is a safe and feasible procedure, even for functioning masses and pheochromocytomas. A multidisciplinary team including endocrinologists, endocrine surgeons and anaesthesiologists, is recommended in the management of adrenal pathology, and adrenal surgery should be performed in referral high volume centers. A thirty-procedures learning curve is recommended to improve surgical outcomes.

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Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Single center experience with laparoscopic adrenalectomy on a large clinical series

et al. 2018

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“…From an international multicenter study with HIPEC following distal pancreatectomy and cytoreductive surgery, the method appears to be reasonable with minor toxicity [36]. Advances in surgery, anaesthesia, and perioperative care have resulted in significant decrease of morbidity and hospital mortality especially in high-volume centres even in elderly patients [37][38][39]. Although it is obvious that all patients underwent treatment in a small-volume centre, the hospital morbidity and mortality are acceptable.…”

Section: Discussionmentioning

confidence: 99%

The effect of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) as an adjuvant in patients with resectable pancreatic cancer

Tentes

Stamou

Pallas

et al. 2016

International Journal of Hyperthermia

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“…Однако существуют публикации, в которых оценены результаты лечения пациентов старше 80 [22] или 90 [5] лет. Так, в ряде работ [22][23][24][25][26][27] не выявлено различий летальности в разных возрастных группах. В других сериях [5,[28][29][30][31][32], наоборот, данная зависимость продемонстрирована.…”

Section: Discussionunclassified

Short-term results of pancreatoduodenectomy in patients over 70 years old

Shatveryan¹,

Chardarov²,

Nikoda³

et al. 2020

Khir. Z. im. N.I. Pirogova

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Частота опухолевых поражений периампулярной области увеличивается с возрастом, что обусловливает рост числа пациентов старших возрастных групп, которым требуется выполнение панкреатодуоденальной резекции (ПДР). Цель исследования-сравнение ближайших результатов ПДР у пациентов моложе 70 лет и старше 70 лет. Материал и методы. В исследование включены пациенты, которым выполнена ПДР по различным показаниям в период с марта 2010 по февраль 2019 г. Все пациенты разделены на две группы: моложе 70 лет и старше 70 лет. Послеоперационная летальность и частота осложнений служили первичными конечными точками исследования. Результаты. В течение 9 лет выполнено 110 ПДР. В группу пациентов моложе 70 лет (1-я) включены 93 пациента. В группу пациентов в возрасте старше 70 лет (2-я) вошли 17 пациентов. Показатели ASA (American Society of Anesthesiologists) и индекс PMP (Preoperative Mortality Predictor) во 2-й группе были выше-соответственно 3 (2-3) и 2 (1-3) балла (p=0,002) и 12 (6-15) и 6,5 (5-15) балла (p<0,001). Летальность во 2-й группе была выше (11,7 и 3,2%), но различия статистически незначимы (p=0,16). Частота всех осложнений (72 и 76%; p=1,0), «больших» осложнений grade ≥IIIa (29 и 29%), гастростаза grade B/C (17,2 и 17,6%), панкреатической фистулы grade B/C (23,6 и 35,3%; p=0,3), желчной фистулы grade B/C (7,5 и 11,8%; p=0,62), срок пребывания в стационаре после операции (22 (8-165) и 23 (9-71) койко-дня; p=0,92) в группах статически значимо не различались. Заключение. Ближайшие результаты ПДР в группах пациентов моложе 70 лет и старше 70 лет сопоставимы, несмотря на более высокие показатели ASA и PMP во 2-й группе. При отборе пациентов для ПДР (при условии резектабельности опухоли) необходимо учитывать общий статус пациентов и наличие сопутствующих заболеваний. Возраст сам по себе не является основанием для отказа от операции.

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Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head is justified in elderly patients: A Retrospective Cohort Study

Cited by 47 publications

References 20 publications

Single center experience with laparoscopic adrenalectomy on a large clinical series

Single center experience with laparoscopic adrenalectomy on a large clinical series

The effect of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) as an adjuvant in patients with resectable pancreatic cancer

Short-term results of pancreatoduodenectomy in patients over 70 years old

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