Surgical Treatment of Pancreatic Head Carcinoma in Elderly Patients

Abstract

The treatment of cancer in elderly patients has become a global clinical issue, considering the increasingly longer life expectancy. Three quarters of patients with pancreatic adenocarcinoma are older than 60 years. Surgical resection is the only chance of cure, and early outcome of pancreaticoduodenectomy in elderly patients is comparable with that obtained in a younger population. Design: During an 11-year period, 166 patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. Clinical and demographic factors were evaluated by univariate and multivariate analyses to test their effect on early outcome. Setting: State university medical school tertiary care center. Patients: One hundred sixty-six patients underwent curative pancreaticoduodenectomy for pancreatic adenocarcinoma. They were divided into 2 groups according to age (group A for patients older than 70 years, group B for patients younger than 70 years). Intervention: Pancreaticoduodenectomy was performed using a Whipple procedure. An end-to-end pancreaticojejunostomy was constructed. Lymphadenectomy was carried out along the hepatoduodenal ligament, common hepatic artery, vena cava, superior mesenteric vein, and along the right side of the superior mesenteric artery. Four abdominal drainage sites were routinely used. Main Outcome Measures: The postoperative hospital stay was calculated and morbidity and mortality were assessed.

Incidence of and Risk Factors and Reinterventions for Post-Pancreatoduodenectomy Hemorrhage: Retrospective Analysis

“…Surgical complications that lead to reoperation have been reported as responsible for the high mortality rate in older patients with PDAC who undergo PD [22]. Moreover, a retrospective study found that even modest levels of preoperative hypoproteinemia (30≤ albumin <35 g/L) increased postoperative complications after colorectal surgery.…”

Age does not affect complications and overall survival rate after pancreaticoduodenectomy: Single-center experience and systematic review of literature

“…A total of 21 studies were identified (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). A total of 6,933 PDs were collected, and of these, 1,931 PDs (27.9%) were performed in elderly patients.…”

Pancreatic resection in the elderly

“…Die Frage, ob resezierende Pankreaseingriffe im Alter gerechtfertigt sind, hat schon mehrere Arbeitsgruppen und Kliniken beschäftigt [1,2,3,4,5,6,7,8,9,10,11,13,14]. Wohl in der Annahme, dass es sich bei der Pankreaskopfresektion um den komplexeren Eingriff handelt, wurden postoperative Mortalität und Morbidität fast ausschließlich in Bezug zur Pankreatikoduodenektomie untersucht.…”

“…Lebensjahr eine hö-here operative Morbidität und Mortalität beschreiben [1]. Obwohl ein aggressives chirurgisches Vorgehen als gerechtfertigt angesehen wird, werden hier chirurgische Komplikationen als Ursache für die erhöhte Mortalität bei den älteren Patienten benannt [1]. Dies ließ sich an unserem Patientengut nicht nachvollziehen.…”