Pancreaticoduodenectomy in patients ≥ 75 years of age: Are there any differences with other age ranges in oncological and surgical outcomes? Results from a tertiary referral center

Abstract

AIMTo compare surgical and oncological outcomes after pancreaticoduodenectomy (PD) in patients ≥ 75 years of age with two younger cohorts of patients.METHODSThe prospectively maintained Institutional database of pancreatic resection was queried for patients aged ≥ 75 years (late elderly, LE) submitted to PD for any disease from January 2010 to June 2015. We compared clinical, demographic and pathological features and survival outcomes of LE patients with 2 exact matched cohorts of younger patients [≥ 40 to 64 years of age (adults, A) and ≥ 65 to 74 years of age (young elderly, YE)] submitted to PD, according to selected variables.RESULTSThe final LE population, as well as the control groups, were made of 96 subjects. Up to 71% of patients was operated on for a periampullary malignancy and pancreatic cancer (PDAC) accounted for 79% of them. Intraoperative data (estimated blood loss and duration of surgery) did not differ among the groups. The overall complication rate was 65.6%, 61.5% and 58.3% for LE, YE and A patients, respectively, P = NS). Reoperation and cardiovascular complications were significantly more frequent in LE than in YE and A groups (P = 0.003 and P = 0.019, respectively). When considering either all malignancies and PDAC only, the three groups did not differ in survival. Considering all benign diseases, the estimated mean survival was 58 and 78 mo for ≥ and < 75 years of age (YE + A groups), respectively (P = 0.012).CONCLUSIONAge is not a contraindication for PD. A careful selection of LE patients allows to obtain good surgical and oncological results.

Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

“…Data regarding oncological outcomes after pancreatic surgery for malignancies in the elderly are controversial so far. Some authors report that the elderly population shows a worse outcome [5,17]; however, other groups did not find any significant survival difference [4,9,28]. This heterogeneity of results is probably due to selection biases, but our sample also shows a comparable overall survival between older and younger groups.…”

“…In this study, the "frailty" of elderly patients is confirmed by a significantly higher rate of ASA Score 3 and a poorer performance status compared to younger patients (Table 1); however, intraoperative data did not show significant differences in terms of operative time, blood loss, lymph node retrieval, and radicality of resection, demonstrating that surgical technique and extent of resection is not affected by age of patients [9]. Considering postoperative mortality (90-day mortality), our data suggest a trend towards a worse outcome in the elderly group even though this is without statistical significance; a lack of significance could be related to sample size, but it is important to consider that in-hospital deceases, directly related to surgical operation, were similar (1 in group I and 1 in group II), while the other 2 deaths among older patients occurred from heart failure after discharge.…”

“…Pancreatoduodenectomy (PD) is still burdened by high rates of morbidity and mortality, ranging from 35% to 51% and from 1% to 6%, respectively [6][7][8], and the role of age in surgical outcome is still debated [9,10]. Furthermore, elderly are less likely to receive proper adjuvant chemotherapy, and this could make surgery less effective [11].…”

Ampullary adenocarcinoma: Defining predictors of survival and the impact of adjuvant therapy following surgical resection for stage I disease

“…That older age is negatively associated with OS in this analysis may in part, be related to additional comorbidities and shorter overall life expectancy in this age group as well as the extent of surgery required. Although some series have reported higher rates of surgical morbidity in elderly patients undergoing pancreatoduodenectomy, these reports have generally referred to octogenarian or more elderly patients . We submit that treatment for AAC not be based on any specific age, but rather an overall assessment of the individual patients' performance status, social support, and personal decisions based on appropriate information and education regarding the risks and benefits of therapy.…”

“…Although some series have reported higher rates of surgical morbidity in elderly patients undergoing pancreatoduodenectomy, these reports have generally referred to octogenarian or more elderly patients. [11][12][13][14][15] We submit that treatment for AAC not be based on any specific age, but rather an overall assessment of the individual patients' performance status, social support, and personal decisions based on appropriate information and education regarding the risks and benefits of therapy. and potentially under treatment for these patients.…”