Results of pancreatic surgery in the elderly: is age a barrier?

Oliveira‐Cunha, Melissa; Malde, Deep J.; Aldouri, Amer; Morris‐Stiff, Gareth; Menon, Krishna; Smith, Andrew M.

doi:10.1111/j.1477-2574.2012.00549.x

Cited by 63 publications

(47 citation statements)

References 21 publications

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“…Our findings are in accordance with the recent Dutch guideline on pancreatic cancer [17], stating that high age alone should not be a contraindication for pancreatic surgery. The proportion of octogenarians in our study (4.7%), however, was in the lower range compared to reports from specialised centres (4.5-17%) [5][6][7][8] and compared to population-based studies on this subject reporting 5.7-12.4% octogenarians [3,4,10]. Despite increasing resection rates in the course of our study, 30-day postoperative mortality slightly decreased in elderly patients who underwent resection for pancreatic or periampulary carcinoma.…”

Section: Discussioncontrasting

confidence: 55%

“…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: 83%

“…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%

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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

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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.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 83%

mentioning

confidence: 99%

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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

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“…Elderly patients will likely have more pre-operative comorbidities affecting peri-operative morbidity and mortality, and surgeons will be required to determine which elderly patients will be reasonable surgical candidates. Previous studies have shown varied clinical outcomes of elderly patients undergoing PD (7)(8)(9)(10)(11)(12)(13)(14). While there are studies that suggest advanced age to be a risk factor associated with increased postoperative complications and mortality after PD (7,8), others have shown no increased risk with advanced age (9)(10)(11)(12)14).…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of pancreaticoduodenectomy in octogenarians: a surgeon’s experience from 2007 to 2015

Liang¹,

Shirkey²,

Rosenberg³

et al. 2016

J. Gastrointest. Oncol.

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Background: As the number of elderly people in our population increases, there will be a greater number of octogenarians who will need pancreaticoduodenectomy as the only curative option for periampullary malignancies. This study evaluated clinical outcomes of pancreaticoduodenectomy in octogenarians, in comparison to younger patients. were similar in two cohorts; however octogenarians had a higher incidence of pulmonary embolism (P=0.02). Conclusions: Our data demonstrates that octogenarians can undergo pancreaticoduodenectomy with outcomes similar to those in younger patients. Thus, patients should not be denied a curative surgical option for periampullary malignancy based on advanced age alone.

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“…Furthermore, few authors have evaluated the short-and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients aged 75 years and older. [8][9][10][11] Therefore, the short-term outcomes and long-term survival of pancreatic resection for pancreatic adenocarcinoma in elderly patients are still unclear. In addition, generally, elderly patients often have comorbidities and age-related physiologic problems that can lead to greater postoperative complications or poor survival than in nonelderly patients.…”

mentioning

confidence: 99%

The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

Aoyama

Murakawa

Atsumi

et al. 2016

International Surgery

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The short-and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been fully evaluated in elderly patients. This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into 2 groups: nonelderly patients (age , 75 years; group A) and elderly patients (age 75 years; group B). The surgical morbidity, surgical mortality, overall survival (OS), and recurrence-free survival (RFS) rates in the 2 groups were compared. A total of 221 patients were evaluated in the study. The overall complication rates were 44.8% in group A and 52.6% in group B. Surgical mortality was observed in 2 patients due to an abdominal abscess and cardiovascular disease in group A (1.1%) and in 1 patient due to postoperative bleeding in group B (2.6%). There were no significant differences (P ¼ 0.379 and P ¼ 0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and nonelderly patients (18.55 versus 20.2%, P ¼ 0.946 and 13.1% versus 16.0%, P ¼ 0.829, respectively). The short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the nonelderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.Key words: Pancreatic cancer -Elderly patient -Pancreatic resection P ancreatic cancer is one of the most lethal human cancers. It is the fifth-most common cancer and the fourth leading cause of cancer-related mortality worldwide, with a 5-year survival rate of less than 5% in all stages.1,2 Complete resection is essential for obtaining a cure in patients with pancreatic cancer. However, the morbidity after pancreatic resection has been reported to range from 30% to 65%, and the complications are sometimes fatal. [3][4][5][6][7] The number of elderly patients is rapidly growing worldwide. With people aged 75 and older representing the fastest growing subset of the population, the management of complex surgical issues promises to become even more challenging. However, previous studies excluded patients over the age of 75. Furthermore, few authors have evaluated the short-and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients aged 75 years and older. [8][9][10][11] Therefore, the short-term outcomes and long-term survival of pancreatic resection for pancreatic adenocarcinoma in elderly patients are still unclear. In addition, generally, elderly patients often have comorbidities and age-related physiologic problems that can lead to greater postoperative complications or poor survival than in nonelderly patients.We retrospectively investigated the short-term outcomes and long-term survival after pancreatic resection for pancreatic adenocarcinoma in patients older than 75 years and compared them with nonelderly patients. Patients and Methods PatientsThe study subjects were selected from t...

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Results of pancreatic surgery in the elderly: is age a barrier?

Cited by 63 publications

References 21 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

Clinical outcomes of pancreaticoduodenectomy in octogenarians: a surgeon’s experience from 2007 to 2015

The Short- and Long-Term Outcomes of Pancreatic Resection for Pancreatic Adenocarcinoma in Patients Older Than 75 Years

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